{"rowid": 10516, "facility_name": "MAGNOLIA MANOR METHODIST NSG C", "facility_id": 115004, "address": "2001 SOUTH LEE STREET", "city": "AMERICUS", "state": "GA", "zip": 31709, "inspection_date": "2009-08-20", "deficiency_tag": 504, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "3EK711", "inspection_text": "**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 laboratory tests were obtained as ordered for five residents (#5, #7, #18, #19 and #30) from a total sample of 30 residents. Findings include: 1. Resident #18 had a 1/16/09 physician's orders [REDACTED]. A review of the resident's medical record revealed [REDACTED]. However, there was not a physician's orders [REDACTED]. 2. Resident #19 had a 1/21/09 physician's orders [REDACTED]. A review of the resident's medical record revealed [REDACTED]. However, there was not a physician's orders [REDACTED]. During an interview on 8/20/09 at 11:45 a.m., licensed nurse \"DD\" stated that the additional laboratory tests performed for residents #18 and #19 were obtained in error and did not have a physician's orders [REDACTED]. 3. Resident #5 had a physician's orders [REDACTED]. A review of the resident's medical record revealed [REDACTED]. However, there was not a physician's orders [REDACTED]. 4. Resident #7 had a Complete Metabolic Panel (CMP) obtained on 5/13/09 and 5/14/09. However, review of the resident's medical record revealed [REDACTED]. 5. Review of resident #20's closed record revealed a 3/30/09 physician's orders [REDACTED]. A review of the resident's medical record revealed [REDACTED]. However, nursing staff did not have a physician's orders [REDACTED]. During an interview on 8/20/09 at 11:15 a.m., licensed nurse \"CC\" stated that the additional laboratory tests performed on residents #5 and #7 were obtained in error. Nursing staff did not have a physician's orders [REDACTED].", "filedate": "2014-04-01"}
{"rowid": 10517, "facility_name": "MAGNOLIA MANOR METHODIST NSG C", "facility_id": 115004, "address": "2001 SOUTH LEE STREET", "city": "AMERICUS", "state": "GA", "zip": 31709, "inspection_date": "2009-08-20", "deficiency_tag": 325, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "3EK711", "inspection_text": "**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 resident's attending physician reviewed and addressed the registered dietician's recommendations timely for five residents (#6, #18, #19, #26 and #30), and failed to follow a physician's orders [REDACTED].#2) of 15 residents with weight loss from a total sample of 30 residents. Findings include: 1. Resident #18 had [DIAGNOSES REDACTED]. Licensed staff coded the resident as independent in eating on the 4/1/09 Significant Change of Condition comprehensive assessment. He/She was on a Regular diet. Resident #18 had a 5/20/09 and 6/17/09 registered dietician's recommendation for 30 milliliters (ml) of protein supplement twice a day because of his/her significant weight loss of 10% in six months, a low [MEDICATION NAME] level and meal intake of less than 75%. Staff recorded the resident's weight as 188.8 pounds in May, 186.2 in June and 181.8 in July, 2009. The resident's [MEDICATION NAME] level on 6/1/09 was below normal at 18 (normal range, 20-40). However, despite the continued gradual weight loss and low [MEDICATION NAME] level, the resident's attending physician did not act on those recommendations until 7/21/09 (34 days later) at which time the physician ordered the protein supplement. 2. Resident #6 had [DIAGNOSES REDACTED]. Licensed staff coded the resident as independent with eating on the 4/11/09 MDS assessment. Resident #6 had a 4/22/09 registered dietician's recommendation for fortified meals because of meal intake of less than 75%, a body mass index (BMI) of less than 19, having wounds, a low [MEDICATION NAME] and a low [MEDICATION NAME] level. The resident's 4/9/09 [MEDICATION NAME] level was 10.7 (normal range 20-40) and his/her [MEDICATION NAME] level was 3.0 (normal range 3.4-4.8). However, despite the decreased intake, the recorded BMI of less than 19, and the low [MEDICATION NAME] and [MEDICATION NAME] levels, the resident's attending physician did not act on that recommendation until 6/10/09 (49 days later) at which time the physician ordered the fortified meals. 3. Resident #30 had [DIAGNOSES REDACTED]. Review of his/her closed record revealed a 3/19/09 registered dietician's recommendation for fortified meals and for 90 cubic centimeters (cc) of Med Pass 2.0 kcal/cc to be given three times every day because of a 10.3% significant weight loss in 30 days (from 174 pounds in February to 160.6 in March, 2009), a less than 50% meal intake, having wounds and a low [MEDICATION NAME] level. His/Her 3/15/09 [MEDICATION NAME] level was 2.4 (normal range 3.5-5.0). However, despite the weight loss, decreased intake, and low [MEDICATION NAME] level, the resident's attending physician did not act on those recommendations until 4/30/09 (42 days later) at which time the physician ordered 240 cc of Glucerna to be given to the resident twice every day. 4. Resident #2 had [DIAGNOSES REDACTED]. He/She had an 8.9 percent gradual weight loss in six months from 141 pounds in 1/09 to 128.6 pounds in 7/09. Staff had interventions in place to prevent additional weight loss such as a speech therapy evaluation and diet change on 3/6/09, an intervention for staff to feed the resident and the initiation of a supplement, Hi Cal 120 cubic centimeters (cc), three times a day on 4/20/09. The resident had a 7/29/09 physician's orders [REDACTED]. However, a review of the resident's clinical record revealed that staff had continued to give the resident the HI Cal only three times a day from 8/1/09 to 8/18/09. According to the weekly weight record, the resident had continued to lose an additional 6.6 pounds (5.1 percent) in 21 days from 128.6 pounds on 7/29/09 to 122 pounds on 8/19/09. 5. Resident #26 had [DIAGNOSES REDACTED]. He/She had a significant weight gain from his/her admission weight of 130 pounds on 8/19/03 to 202 pounds in 1/09. The resident then had a 14 percent weight loss in six months from 202 pounds in 1/09 to 173.6 pounds in 7/09. Staff had interventions in place to prevent additional weight loss such as a , an increase in pain medication for better pain control, the initiation of a supplement (30 cc of ProMod three times a day), and a psychiatric evaluation to address the resident's depression. Staff also obtained an order for [REDACTED]. weight loss in six months, his/her meal intake of less that 50 percent and his/her low [MEDICATION NAME] and [MEDICATION NAME] levels. The resident's 7/8/09 [MEDICATION NAME] level was 15.6 (normal range of 20-40) and his/her 7/22/09 [MEDICATION NAME] level was 2.8 (normal range 3.5-5.0). However, the resident's attending physician did not act on the registered dietician's recommendation until 14 days later on 8/5/09 when he/she ordered staff to increase the ProMod to 60 cc three times a day. Although the resident's weight had been stable at 173 pounds from 5/09 to 7/09, the resident had lost an additional amount of weight from 173.6 pounds in 7/09 to 155.2 pounds on 8/5/09 (10.5 percent loss). 6. Resident #19 had [DIAGNOSES REDACTED]. Licensed staff coded him/her as independent with eating on the 4/9/09 Significant Change of Condition comprehensive assessment. He/She was on a Regular, No Added Salt (NAS) diet. Resident #19 had a 5/20/09 dietician's recommendation for a protein supplement every day because of a greater that 10% weight loss in 6 months and meal intake of less than 75%. The RD recommendation form in the resident's clinical record had been signed but not dated by the physician. There was another copy of that recommendation form on which a licensed nurse had written on it that she had faxed it to the physician's office on 6/4/09. However, despite the resident's weight loss (from 164.4 pounds in January to 147.8 in June 2009), there was no evidence that the physician acted on the recommendation until 6/24/09, when there was a physician's orders [REDACTED]. During an interview with the registered dietician on 8/19/09 at 4:15 p.m., he/she stated that he/she was aware that the physicians were not reviewing and addressing his/her recommendations timely. During an interview on 8/20/09 at 8:30 a.m., licensed nurse \"DD\" stated that the registered dietician gave the recommendations to the nursing office, then they were copied and placed on the resident's charts. \"DD\" said that those recommendations were not reviewed and acted on until the resident's attending physician came to visit the resident.", "filedate": "2014-04-01"}
{"rowid": 10518, "facility_name": "MAGNOLIA MANOR METHODIST NSG C", "facility_id": 115004, "address": "2001 SOUTH LEE STREET", "city": "AMERICUS", "state": "GA", "zip": 31709, "inspection_date": "2009-08-20", "deficiency_tag": 282, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "3EK711", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and record review, it was determined that the facility failed to implement the plan of care to prevent falls for one resident (#27) of six residents with a history of falls from a total sample of 30 residents. Findings include: Resident #27 had a history of [REDACTED]. However, on 8/20/09 at 9:15 a.m., 10:15 a.m., 11:50 a.m. and 12:50 p.m., the resident was sitting in his/her wheelchair, but staff had failed to apply the chair alarm. See F323 for additional information regarding resident #27.", "filedate": "2014-04-01"}
{"rowid": 10519, "facility_name": "MAGNOLIA MANOR METHODIST NSG C", "facility_id": 115004, "address": "2001 SOUTH LEE STREET", "city": "AMERICUS", "state": "GA", "zip": 31709, "inspection_date": "2009-08-20", "deficiency_tag": 428, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "3EK711", "inspection_text": "**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 resident's attending physician acted on the consultant pharmacist's recommendations in a timely manner for nine residents (#2, #3, #9, #18, #19, #20, #24, #27 and #30) from a total sample of 30 residents. Findings include: 1. Resident #18 had a 7/30/09 consultant pharmacist recommendation to increase the dose of Stalevo to aid in reducing the potential of falls and to change the time of the resident's Flomax from morning to hour of sleep to reduce any orthostatic hypotension to aid in reducing falls. However, the physician did not act on those recommendations until 8/19/09, at which time he/she increased the dose of Stalevo and changed the time of administering of Flomax to bedtime. 2. Resident #19 had a 3/26/09 consultant pharmacist recommendation for a [DIAGNOSES REDACTED]. However, the physician did not act on that recommendation until 5/27/09, at which time he/she gave a [DIAGNOSES REDACTED]. 3. Resident #20 had a 7/30/09 consultant pharmacist recommendation for the resident's Miralax be mixed with 8 ounces of water or juice according to the manufacturer's recommendations instead of the 4 ounces of liquid that the nursing staff had been administering. However, the physician did not act on that recommendation until 8/18/09, at which time he/she ordered nursing staff to give the Miralax with 8 ounces of water or juice. The resident also had a 6/30/09 consultant pharmacist recommendation for a potassium replacement due to the resident receiving HCTZ daily without a potassium supplement. The resident's 6/30/09 potassium level was low at 3.1 (normal range 3.5-5.3). However, the physician did not act on that recommendation until 7/15/09, at which time, he/she ordered 20 miliequivalents (meq) of KDur daily. During an interview on 8/20/09 at 8:30 a.m., licensed nurse \"DD\" stated that the consultant pharmacist gave the recommendations to the Director of Nursing, then they were copied and placed on the residents' charts. \"DD\" said that those recommendations were not reviewed and acted on until the resident's attending physician's next visit to the resident. 4. Review of resident #30's closed record revealed a 3/26/09 consultant pharmacist recommendation for a proton pump inhibitor (PPI) due to a recent hospitalization for a gastrointestinal bleed. However, the resident's attending physician did not act on that recommendation until 4/30/09. At that time, he/she ordered 40 milligrams of Protonix every day. 5. Resident #2 had consultant pharmacist recommendations dated 6/30/09 for a Complete Blood Count (CBC) to be done every six months due to the resident's previously low hemoglobin and hematocrit levels, and a recommendation to reduce the dosage of Atenolol from 100 milligrams (mgs) to 50 mgs daily due to the resident's renal insufficiency. However, review of the resident's clinical record revealed that although the physician had assessed the resident on 7/22/09, he/she had not acted on the recommendation for a CBC to be done every six months. After surveyor inquiry on 8/19/09, when supervisory nursing staff \"EE\" notified the physician about that consultant pharmacist's recommendation for a CBC every six months, he ordered the laboratory test to be done. Although the physician documented in his 7/22/09 progress notes that he did not change any of the resident's medications on that day, he failed to document his analysis of the risks versus the benefits from the resident's continued use of 100 milligrams of Atenolol every day. 6. Resident #3 had a physician's orders [REDACTED]. On 6/30/09, the consultant pharmacist recommended a dose reduction of the Ambien to 5 milligrams every night as needed. However, review of the resident's clinical record revealed that although the physician had assessed the resident on 7/22/09 and 8/12/09, he/she failed to act on that recommendation. 7. Resident #27 had a physician's orders [REDACTED]. On 6/30/09, the consultant pharmacist recommended that the order be clarified to 1 capful, or 17 grams, of Miralax in 8 ounces of water. However, review of the resident's clinical record revealed that the physician had failed to act on that recommendation. Resident #27 had a history of [REDACTED]. The resident had a physician's orders [REDACTED]. On 7/30/09, the consultant pharmacist recommended a reduction in the frequency of the Restoril to every night as needed or to change the medication to an alternative sleep aid. However, review of the resident's clinical record revealed that the physician had failed to act on that recommendation. On 8/19/09 at 11:30 a.m., supervisory nursing staff \"EE\" stated that nursing staff put the consultant pharmacist's recommendations on the residents' charts for the physicians to review. However, \"EE\" stated that none of the nursing staff was responsible for ensuring that the physicians saw those recommendations that had been placed on the charts. 8. Resident #24 had a 5/27/09 pharmacy recommendation that reported that since 5/7/09 nursing staff had been giving him/her Diabetic Robitussin every four hours around the clock. The pharmacist requested that the physician clarify if the medication was intended to be given around the clock or as needed. However, the physician did not act on the pharmacist's request until 7/8/09 when he/she ordered to discontinue the medication. 9. Resident #9 had a 7/30/09 pharmacy recommendation for a trial dose reduction of Zyprexa 5 milligrams twice a day and to evaluate if Zinc and Vitamin C were still indicated. However, as of 8/20/09, the physician had not acted on those recommendations.", "filedate": "2014-04-01"}
{"rowid": 10520, "facility_name": "MAGNOLIA MANOR METHODIST NSG C", "facility_id": 115004, "address": "2001 SOUTH LEE STREET", "city": "AMERICUS", "state": "GA", "zip": 31709, "inspection_date": "2009-08-20", "deficiency_tag": 225, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "3EK711", "inspection_text": "**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 thoroughly investigate the past history of one of sixteen employees, and failed to report one injury of unknown origin to the State survey and certification agency. Findings include: 1. According to the 4/30/09 nurse's notes at 1:40 p.m., resident #12 had [MEDICAL CONDITION] and discoloration on his/her right hand, wrist and lower forearm, and complained of pain. The resident was sent to the emergency room (ER) for evaluation. It was determined that he/she did not have a fracture but had a contusion of the right wrist. Although the facility had investigated that injury and determined it had been of unknown origin, it was not reported to the State survey and certification agency. 2. Review of the personnel records for sixteen employees revealed that the facility hired an employee on 9/22/08. However, the facility failed to thoroughly investigate his/her history including having obtained a current criminal background check prior him/her working at the facility. On 8/20/09 at 1:00 p.m., the administrator stated that the facility staff were unable to locate the background check.", "filedate": "2014-04-01"}
{"rowid": 10521, "facility_name": "MAGNOLIA MANOR METHODIST NSG C", "facility_id": 115004, "address": "2001 SOUTH LEE STREET", "city": "AMERICUS", "state": "GA", "zip": 31709, "inspection_date": "2009-08-20", "deficiency_tag": 323, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "3EK711", "inspection_text": "**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 provide a chair alarm as planned to prevent falls for one resident (#27) of six residents with a history of falls from a total sample of 30 residents and failed to ensure that two handrails were secured to the wall on one unit (Unit IV) of five units in the facility. Findings include: 1. Resident #27 had a history of [REDACTED]. However, on 8/20/09 at 9:15 a.m., 10:15 a.m., 11:50 a.m. and 12:50 p.m., the resident was sitting in his/her wheelchair, but staff had failed to apply the chair alarm. On 8/20/09 at 12:50 p.m., certified nursing assistant \"AA\" confirmed that the resident did not have a chair alarm on his/her wheelchair. \"AA\" stated at that time that staff did not apply an alarm on the resident's wheelchair. On 8/20/09 at 12:55 p.m., licensed nursing staff \"BB\" stated that staff did not apply an alarm on the resident's wheelchair because, the resident did not attempt to get out of his/her wheelchair unassisted. However, according to the 7/15/09 at 9:10 p.m. nurses' notes, nursing staff had found the resident on the floor in his/her room next to his/her wheelchair. 2. During the General Observation Tour of the Facility on 8/20/09 at 11 a.m., two sections of handrails were loose in the Unit IV hall between the common bath and the residents' telephone room, and between rooms 442 and 440.", "filedate": "2014-04-01"}
{"rowid": 10522, "facility_name": "MAGNOLIA MANOR METHODIST NSG C", "facility_id": 115004, "address": "2001 SOUTH LEE STREET", "city": "AMERICUS", "state": "GA", "zip": 31709, "inspection_date": "2009-08-20", "deficiency_tag": 505, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "3EK711", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, it was determined that the facility failed to promptly notify the physician about an abnormally high [MEDICATION NAME]/INR level and an abnormally high BUN level for one resident (#3) from a sample of 30 residents. Findings include: Nursing staff had given 5 milligrams (mgs) of [MEDICATION NAME] daily to resident #3 since his/her admission on 6/9/09. Licensed nursing staff had obtained a [MEDICATION NAME]/INR blood level on the resident on 6/15/09. Although, the INR was abnormally high at 3.69 (therapeutic range was between 2.0 and 3.0), licensed nursing staff had failed to notify the physician about that result until 7/7/09 (22 days later). At that time, the physician ordered nursing staff to hold the [MEDICATION NAME] that day and then decrease the dose to 2.5 mgs and alternating that with 5 mgs every other day. On 8/19/09 at 11:00 a.m., the consultant pharmacist stated that licensed nursing staff should have notified the resident's physician about the abnormally high INR result prior to 7/7/09. Resident #3 had an abnormally high BUN level of 52 reported on 8/4/09. The normal range for a BUN level was between 7 and 18. Although the resident had an abnormally high BUN level of 31 on 6/6/09 prior to his/her admission to the facility on [DATE], there was no evidence that licensed nursing staff had notified the resident's physician about the even higher BUN result on 8/4/09.", "filedate": "2014-04-01"}
{"rowid": 10523, "facility_name": "MAGNOLIA MANOR METHODIST NSG C", "facility_id": 115004, "address": "2001 SOUTH LEE STREET", "city": "AMERICUS", "state": "GA", "zip": 31709, "inspection_date": "2009-08-20", "deficiency_tag": 253, "scope_severity": "C", "complaint": null, "standard": null, "eventid": "3EK711", "inspection_text": "Based on observations, it was determined that the facility failed to maintain an environment that was free from dust, rust, stains, missing baseboards, dirt, cobwebs and/or debris on all five hallways in the facility. Findings include: The following were observed on 8/18/09 between 8:55 a.m. and 11:00 a.m. and on 8/20/09 at 10:00 a.m. and 11:00 a.m. 500 Hall 1. There were rusty metal bedpan holders mounted on the bathroom walls in rooms 522 and 523. 2. There was a heavy build up of dust on the bathroom ceiling vents in rooms 523, 540, 541, 542, 543, 545 and 547. 3. There were rusty metal bases on the suction machines in rooms 512 and 541. 4. The laminate finish was peeling off of the side of the nightstand in room 544. 5. There were cobwebs on the furniture in room 531. 6. There was a dried brown liquid substance on the bathroom ceiling light fixtures in rooms 526 and 528. 7. The bathroom light fixture in room 526 was separated from the ceiling on two sides. 8. There was a Exelon medication patch dated 7/5/09 attached to the shower wall in room 521. 9. There were scuffs and gouges on the door of the common bath. 10. There was approximately a five foot section of baseboard missing in the dining area. 11. There was a section of baseboard missing in the hall next to the supply closet. 400 Hall 1. There were scuffs and paint peeling off of the wall next to the linen storage room. 2. There were scuffs and gouges on the door of the common bath. 3. The baseboards were scuffed and stained in the television area. 4. There were stains and paint peeling off of the bottom cabinets in the clean utility room. 300 Hall 1. There was a heavy build up of dust on the ceiling vents in rooms 310 and 331. 2. There were rusted out areas at the bottom of the bathroom door frames in rooms 313 and 331. 3. There were rusty grab bars in the bathrooms in rooms 315, 320 and 342. 4. There were dried brown stains on the bathroom ceiling in room 344. 5. There were dried brown splatter stains on the walls and ceiling of the soiled linen room. 6. There were dried brown splatter stains on the hallway ceiling next to room 343. 200 Hall 1. The light fixture cover was loose from its base in the soiled linen room. 2. There were stains on the vents on the lower portion of the water fountain and the tile backsplash. 3. There was a build-up of dust on the ceiling vent in the toilet area of the common bath. 100 Hall 1. There was a build-up of a black substance on the drain in the water fountain. There were stains on the vents on the bottom section of the fountain and on the tile backsplash. 2. There was a build-up of dust on the ceiling vent in the tub area of the common bath. 3. There was a cracked light cover in the dirty utility room.", "filedate": "2014-04-01"}
{"rowid": 10524, "facility_name": "MAGNOLIA MANOR METHODIST NSG C", "facility_id": 115004, "address": "2001 SOUTH LEE STREET", "city": "AMERICUS", "state": "GA", "zip": 31709, "inspection_date": "2009-08-20", "deficiency_tag": 368, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "3EK711", "inspection_text": "Based on group interview and staff interview, it was determined that the facility failed to offer bedtime snacks to six of fourteen residents who attended the group interview. Findings include: During the group interview on 8/19/09 at 3:00 p.m., six of the fourteen residents said that they were not offered bedtime snacks. During interviews conducted on 8/20/09 between 8:20 a.m. and 9:00 a.m. with the six residents in the group interview who had reported not being offered bedtime snacks, they said that nursing staff did not offer them a bedtime snack on the previous evening (8/19/09). During an interview on 8/20/09 at 9:30 a.m., the Director of Nursing stated that bedtime snacks were kept stocked on the units and nursing staff was responsible for offering them to the residents.", "filedate": "2014-04-01"}
{"rowid": 10525, "facility_name": "BELL MINOR HOME, THE", "facility_id": 115020, "address": "2200 OLD HAMILTON PLACE NE", "city": "GAINESVILLE", "state": "GA", "zip": 30507, "inspection_date": "2009-11-11", "deficiency_tag": 332, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "TBSG11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and record reviews, it was determined that for two (2) of the eight (8) residents observed the facility failed to ensure a medication error rate that was less than 5%. Two (2) of four (4) nurses observed during forty-six (46) opportunities made three (3) errors resulting in a medication error rate of 6.25%. Findings include: During the morning medication pass on 11/10/09 the following errors were observed: 1. A resident on the B 1 Hall was given his medications at 8:45 a.m. Record review for this resident revealed current physician orders [REDACTED]. 2. A resident on the B 2 Hall was given his medications at 8:55 a.m. and an antihypertensive medication, [MEDICATION NAME] was included. The medications were given with water. Review of the current physician's orders [REDACTED]. 3. The same resident on the B 2 Hall was given an anticonvulsant medication, [MEDICATION NAME], 200 milligrams at 8:55 a.m. Review of the current physician's orders [REDACTED].", "filedate": "2014-04-01"}
{"rowid": 10526, "facility_name": "BELL MINOR HOME, THE", "facility_id": 115020, "address": "2200 OLD HAMILTON PLACE NE", "city": "GAINESVILLE", "state": "GA", "zip": 30507, "inspection_date": "2009-11-11", "deficiency_tag": 441, "scope_severity": "F", "complaint": null, "standard": null, "eventid": "TBSG11", "inspection_text": "Based on observation and staff interview the facility failed to ensure for a resident census of one hundred and one (101) that linen was handled in a manner to prevent development or transmission of infection. On 11//10/09 at 10:20 a.m. observations of the laundry room revealed the following: The Housekeeping Supervisor (HS) and the Floor Technician (FT) were observed folding clean linen. The clean sheets were observed to touch the floor, the employees clothing and the employee chin, face, nose and body. Employees HS and FT were observed to handle soiled linen wearing no clothing protectors and only disposable gloves. Personal drink containers were observed on the folding table. Interview at that time with HS revealed they have to work in the laundry a couple of times a week. During a second observation on 11/11/09 at 8:50 a.m. the Housekeeping Supervisor, Floor Technician and a Housekeeper were observed in the laundry folding linen and the linen was again observed to touch the floor. Review of the facility protocol The Laundry Process , 6-15 1/1/2000, section: Transferring Soiled Linen, third paragraph instructs that personal protective equipment is to be used when handling laundry.", "filedate": "2014-04-01"}
{"rowid": 10527, "facility_name": "BELL MINOR HOME, THE", "facility_id": 115020, "address": "2200 OLD HAMILTON PLACE NE", "city": "GAINESVILLE", "state": "GA", "zip": 30507, "inspection_date": "2009-11-11", "deficiency_tag": 253, "scope_severity": "B", "complaint": null, "standard": null, "eventid": "TBSG11", "inspection_text": "Based on observation and staff interview the facility failed to ensure for one (1) of two (2) common bathing areas (B Hall), and for two (2) of twelve (12) rooms observed that the environment was clean and not in need of repairs. Findings include: During environment observations on 11/10/09 at 11:25 a.m. the following was observed: 1. A build up of black mold was observed around the edges of the showers and wall in the common bathing areas on B Hall. Two (2) broken tiles were observed in the shower area. 2. Two (2) air conditioner/heater units in rooms B-23 and B-24 had broken control panel covers. On 11/11/09, accompanied by the Maintenance Director and Housekeeping Director, the common bathing area on B Hall was observed. The black mold in the first shower had been partially removed but the other shower, tub and sink area continued to have black mold and only one (1) of two (2) broken tiles had been repaired.", "filedate": "2014-04-01"}
{"rowid": 10528, "facility_name": "HUTCHESON MED CTR SUBACUTE UNI", "facility_id": 115040, "address": "100 GROSS CRESCENT CIRCLE", "city": "FORT OGLETHORPE", "state": "GA", "zip": 30742, "inspection_date": "2010-12-14", "deficiency_tag": 309, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "7FWP11", "inspection_text": "**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 provide treatments as ordered by the physician for two (2) residents (#s 1 and 2) in a survey sample of six (6) residents. Findings include: 1. Record review for Resident #1 revealed a 10/20/2010 physician's orders [REDACTED]. However, further record review, to include review of the November 2010 Treatment record, revealed no evidence to indicate that this treatment was done on 11/18/2010 at 9:00 a.m., and on 11/01/2010, 11/02/2010, 11/03/2010, 11/23/2010 and 11/27/2010 at 9:00 p.m., as ordered and scheduled. 2. Record review for Resident #2 revealed an 11/04/2010 physician's orders [REDACTED]. However, further record review, to include review of the November 2010 Treatment record, revealed no evidence to indicate that this treatment was done on the 7:00 a.m.-7:00 p.m. shift on 11/07/2010, 11/08/2010, 11/09/2010, 11/12/2010, 11/14/2010, 11/23/2010, 11/26/2010, 11/27/2010, and 11/28/2010, as ordered and scheduled. During an interview with Nurse \"AA\" conducted on 12/14/2010 at 1:45 p.m., this nurse acknowledged that the treatments referenced above were not done as ordered for Resident #1 and Resident #2.", "filedate": "2014-04-01"}
{"rowid": 10529, "facility_name": "PRUITTHEALTH - MACON", "facility_id": 115288, "address": "2255 ANTHONY ROAD", "city": "MACON", "state": "GA", "zip": 31204, "inspection_date": "2011-01-18", "deficiency_tag": 314, "scope_severity": "G", "complaint": null, "standard": null, "eventid": "PDM311", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and resident and staff interview, the facility failed to implement recommended interventions in a timely maner for one (1) resident with a high risk for pressure ulcers. from a sample of six (6) resident. This resulted in actual harm for one (1) resident (#1) that was not immediate jeopardy. Findings include: Review of the medical record for this resident revealed that he was admitted on [DATE] with multiple [DIAGNOSES REDACTED]. The resident had a gastrostomy tube in place for tube feeding. Review of the admission body audit form dated 12/24/10 revealed no open areas on the sacrum, hips, buttocks, ankles, feet and heels. There was a reddened area on the buttocks but was documented as blanchable. Review of the weekly skin assessment performed on 01/03/1, ten days after admission to the facility, revealed the following: right plantar foot #2 stage II 1.8 centimeter (cm) x 1.1 cm with blister right plantar foot #1 stage ll 3.1 cm x 3.2 cm with blister right heel stage I 6 cm x 6 cm with no drainage left plantar foot stage II 3 cm x 4.5 cm with blister left heel unstageable 4 cm x 4 cm suspected deep tissue injury left heel unstageable 3.5 cm x 3.5 cm suspected deep tissue injury left ankle#1 0.5 cm x 0.5 cm x < 0.1 cm with granulation tissue, light drainage let ankle #2 unstageable 1 cm x 1 cm suspected deep tissue injury left ankle #3 stage II 1.1 cm x 1 cm left third toe stage I 0 .5 cm x 0..5 cm left buttocks stage II 1 cm x 2 cm x less than 0.1 cm left buttocks stage III irregular shape with granulation tissue with slough no drainage right buttocks #1 stage I 3 cm x 1.5 cm x < 0.1 cm granulation tissue and slough right great toe stage I I cm x 1 cm no drainage left third toe stage I 0 .5 cm x 0.5 cm During an interview with the Licensed Practical Nurse (LPN) \"AA\" on 01/18/11 at 10:00 a.m. and again at 12:30 p.m. she revealed that she had first assessed the resident on 12/24/10 and on 12/29/10 realized that the resident needed a longer bed for a 74 inch body. Continued interview revealed that even when he sat up in bed at a thirty or a forty-five degree angle his feet pressed against the footboard and created pressure against the balls of his feet. She placed heel boots on his feet but this was not enough to relieve the pressure. Further interview revealed that on 12/29/10 during a \"ZAP\" meeting, when resident needs are addressed, the LPN requested an extra long mattress, as well as, a low air loss mattress for the resident. Upon return to work, on 01/03/11, from scheduled leave time, the LPN assessed the resident's skin and found pressure blisters on the balls of the feet. The resident was still in the same bed as when he was admitted . There was no evidence that a longer mattress or low air loss mattress had been ordered for this resident. These were obtained on 1/03/11. During an interview with the Director Of Nursing (DON) on 01/18/11 at 12:35 p.m. she acknowledged that the LPN had requested the items first during the meeting on 12/29/10 and then again on 01/03/11. She revealed that she had forgotten to place the order. She did add that all residents in the facility are on pressure relief mattresses although not alternating air mattresses. Observation at 9:30 a.m. on 01/18/11 of the resident revealed the upper extremities were contracted and although the resident was diagnosed as a quadriplegic he had enough mobility to use a wedge call button which was close at hand. Interview at 9:30 on 01/18/11 with the resident revealed orientation to time, place, situation, and self. Continued interview revealed that the blistered areas on the feet had occurred because the bed he/she had previously occupied had a mattress that was too short for the resident's 74 inch frame. About a week after admission, the mattress had been ordered and placed on the bed. Further interview revealed that the staff was very good about turning and positioning him/her about every two hours but occasionally would refuse if he had just been positioned after receiving incontinence care and had no complaints about the staff or the care provided. Observation of the resident's wound care on 01/18/2011 at 9:45 a.m., provided by the treatment nurse LPN \"AA\" revealed treatments were applied to multiple pressure ulcers. There were nonstageable darkened blister areas observed on both balls of the feet as well as eschar areas on outer ankles of both feet. The resident was positioned on an low air loss mattress. Review of the medical record revealed a physician's orders [REDACTED]. Further review revealed assessments for potential risk for pressure ulcers documented as high. Review of the careplan from time of admission and updates though 01/03/11 were found including the identification of high risk for skin breakdown 12 24/10. Interventions included barrier creams, turning and repositioning, and by 01/03/11 nutritional supplements, positioning and use of devices, heel protectors, an extra long bed frame and low air loss mattress. Interview on 1/18/11 at 1:48 p.m. with the administrator revealed that the DON did not order the items due to a corporate memo dated 12/28/10 indicating that items could not be ordered except on the order day as noted for each facility. The facility was not listed on the memo. She indicated that the order had to placed through the corporate office. The DON did not write the order until 01/03/11 because there was no point in writing the order until it could be filled Review of the contract with the Durable Medical Equipment (DME) company revealed that the company agrees to use its reasonable best efforts to deliver product to the facility within four hours. Interview on 1/18/11 at 2:05 p.m. with the clerk at the DME company revealed the order had been placed on 01/03/11 and delivered by the evening of 01/03/11.", "filedate": "2014-04-01"}
{"rowid": 10530, "facility_name": "PLACE AT MARTINEZ, THE", "facility_id": 115308, "address": "409 PLEASANT HOME ROAD", "city": "AUGUSTA", "state": "GA", "zip": 30907, "inspection_date": "2011-01-14", "deficiency_tag": 203, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "OC1P11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, and staff and family interview, the facility failed to provide a written notice of discharge to one (1) resident (Resident \"C\"), and to the resident's family, on a survey sample of six (6) residents. Findings include: Review of the medical record for Resident \"C\" revealed a Nurse's Note of 12/27/2010 at 6:00 p.m. which documented that the resident had been evaluated for behavior. A telephone physician's orders [REDACTED]. Interview with the resident's family on 01/14/2011 at 9:45 a.m. revealed that they were told the resident could not return to the facility as the resident was being placed in the ambulance. Interview with the facility Social Worker on 01/14/2011 at 9:20 a.m. confirmed that she had called the hospital, talked to the social worker there and told the hospital staff member that it would not be safe for the resident to return to the nursing facility. However, during this interview, the facility Social Worker further stated that facility staff had not contacted the physician to place in writing why the resident could not return and did not issue the written notice of discharge to the family. Record review revealed no evidence to indicate that a written notice of discharge had been provided to the family, or to the resident, regarding the resident's 12/27/2010 discharge. Interview with the Administrator and the Director of Nurses on 01/14/2011 at 11:30 a.m. revealed that they were not aware they needed to put in writing the reasons for the resident's discharge and issue the written notice of discharge to the resident and to the family.", "filedate": "2014-04-01"}
{"rowid": 10531, "facility_name": "WARRENTON HEALTH AND REHABILITATION", "facility_id": 115321, "address": "813 ATLANTA HIGHWAY", "city": "WARRENTON", "state": "GA", "zip": 30828, "inspection_date": "2013-10-02", "deficiency_tag": 309, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "383J11", "inspection_text": "**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 monitor for the effectiveness of Insulin administration for a high blood sugar level; failed to administer Insulin as ordered by the physician; failed to monitor for signs and symptoms of [MEDICAL CONDITION] ; and failed to document the resident's refusal of care and services for one resident (#1) of three (3) residents with diabetes from a total sample of ten (10) residents. Findings include: Resident #1 was admitted on [DATE] with [DIAGNOSES REDACTED]. The resident had a 9/19/13 physician's orders [REDACTED]. every evening for dementia with behavioral disturbances, [MEDICATION NAME] 50 mg every bedtime for anxiety, [MEDICATION NAME] 5 mg every day for hypertension and [MEDICATION NAME] 5 mg. every bedtime for dementia. The physician also ordered staff to obtain laboratory tests including a comprehensive metabolic profile to be done the next day (9/20/13). The resident was admitted to the secured unit. The resident had an initial care plan dated 9/20/13 with appropriate interventions to address the resident ' s risk for falls; risk for pressure sores, skin tears or bruising; nutrition; potential for pain; potential for high blood pressure; and behaviors (depression, anxiety, aggression and combativeness). On 9/23/13, the results of the laboratory tests were obtained and revealed that the resident had a high glucose level of 455 (normal range was between 65 -100). The physician was notified and ordered staff to administer 15 units of [MEDICATION NAME] every day with supper (scheduled at 5:00 p.m.) and to obtain finger stick blood sugar levels every morning (scheduled for 6:00 a.m.). On 9/23/13, the resident ' s care plan was revised to address his/her new [DIAGNOSES REDACTED]. Licensed nursing staff documented in the 9/24/13 at 5:45 a.m. Interdisciplinary Progress Note (IDPN) that the resident's fingerstick blood sugar was 578 and that the resident was without signs and symptoms of [MEDICAL CONDITION] at that time. The on-call physician was notified and ordered 10 units of Regular Insulin to be administered to the resident \"now\". Review of the MAR for 9/24/13 revealed that the Insulin was administered as ordered by the 7:00 p.m. to 7:00 a.m. nurse. However, there was no indication that licensed nursing staff on the 7:00 a.m. to 7:00 p.m. shift had rechecked the resident's blood sugar level after the administration of the Regular Insulin to evaluate the effectiveness of the Regular Insulin in lowering the resident's blood sugar level. On 9/24/13 at 12:00 p.m., the resident's physician ordered staff to increase the [MEDICATION NAME] to 25 units at supper. However, review of the 9/24/13 MAR indicated [REDACTED]. Furthermore, there was no indication that licensed nursing staff monitored the resident for signs and symptoms of [MEDICAL CONDITION] on the 7:00 a.m. to 7:00 p.m. shift on 9/24/13. Review of the 9/24/13 7:00 a.m. to 7:00 p.m. shift IDPN revealed that licensed nursing staff had documented only on the resident's escalating aggressive behaviors and the monitoring of those behaviors. According to the 9/24/13 at 7:00 p.m. IDPN, the resident was discharged to family because of his/her aggressive behaviors and was to be taken to the hospital for evaluation. Licensed nursing staff documented at that time that the resident was noted with a jerking movement. Review of the 9/24/13 at 8:57 p.m. hospital History and Physical revealed that the resident's glucose level was critically high at 873 (normal was 70-110) , Sodium level was high at 157 (normal was between 136-145), Chloride was 118 (normal was between 98-107), BUN was 29 (normal was between 7-18) and Creatinine level was high at 2.9 (normal was between 0.6-1.3). The resident was uncooperative and nonverbal. The hospital physician documented that the resident had [MEDICAL CONDITIONS] and volume depletion. There were no documented vital signs on the hospital History and Physical. Interview with the Director of Nursing on 10/2/13 at 12:40 p.m.,revealed that the physician usually ordered staff to recheck blood sugar levels within one to two hours after the administration of Regular Insulin for a high blood sugar level. She stated that the on-call physician had not ordered nursing staff to recheck the resident's blood sugar levels on 9/24/13. She stated, however, that she would expect licensed nursing staff to recheck the resident's blood sugar level to evaluate the effectiveness of the Regular Insulin in lowering the resident's blood sugar level and to monitor the resident for [MEDICAL CONDITION] even if the physician did not order it. Interview on 10/2/13 at 4:00 p.m., Licensed Nursing Staff \"AA\" stated via phone that she/he had cared for the resident on 9/24/13 during the 7:00 a.m. to 7:00 p.m. shift. She/he stated that the physician usually ordered staff to recheck the blood sugar level in one to two hours after administering Regular insulin for a high blood sugar level. \"AA\" stated that the physician had not ordered the resident's blood sugar level to be rechecked but that she/he had attempted three times to obtain fingerstick blood sugar levels on the resident on the 7:00 a.m. to 7:00 p.m. shift \"AA\" further stated that the resident had become more combative throughout the day and had refused to let her/him obtain the fingerstick blood sugar levels. \"AA\" stated that the resident also refused to be administered the [MEDICATION NAME] at supper. \"AA\" stated that she/he had forgotten to document about the attempts to obtain the resident's blood sugar levels, the attempt to administer the [MEDICATION NAME] and the resident's refusal of both. Although licensed nursing staff stated that she/he had attempted to obtain fingerstick blood sugar levels on the resident and had attempted to administer the [MEDICATION NAME] at supper on 9/24/13, there was no evidence that licensed nursing staff had attempted to obtain fingerstick blood sugar levels to evaluate the effectiveness of the Regular Insulin to reduce the resident's blood sugar level or to administer the [MEDICATION NAME] to the resident at supper. There was no evidence that the resident had refused to have his/her blood sugar levels checked or that he/she had refused the administration of the [MEDICATION NAME] at supper. There was no evidence that licensed nursing staff had notified the physician that the resident had refused the administration of the [MEDICATION NAME] at supper. There was no evidence that licensed nursing staff had monitored the resident for signs and symptoms of [MEDICAL CONDITION] on the 7:00 a.m. to 7:00 p.m. shift on 9/24/13 prior to his admission to the hospital with a blood sugar level of 873.", "filedate": "2014-04-01"}
{"rowid": 10532, "facility_name": "OAKS - ATHENS SKILLED NURSING, THE", "facility_id": 115419, "address": "139 ALPS ROAD", "city": "ATHENS", "state": "GA", "zip": 30606, "inspection_date": "2011-01-24", "deficiency_tag": 309, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "ZGW511", "inspection_text": "Based on record review and staff interview, the facility failed to provide care as specified by physician's orders for a hospital transfer for one (1) resident (#1) from a survey sample of five (5) residents. Findings include: Record review for Resident #1 revealed a Nurse's Note of 12/12/2010 at 4:00 p.m. which documented that at around 3:15 p.m., the resident pulled the fire alarm and in the process of trying to get away from the alarm, she hit her right forearm on the door frame. This Note documented that nurses noticed bruising and swelling to the right forearm, and that the resident complained of pain to the arm. This Note also documented that the physician was notified and gave an order to transfer the resident to the emergency room . However, a Nurse's Note of 12/12/2010 at 4:45 p.m. documented that the Director of Nursing (DON) stated not to send the resident to the emergency room , that the hospital could not do anything for a hematoma and that it would dissolve on its own. A Nurse's Note of 12/12/2010 at 7:08 p.m. documented that the physician was called to inform him that the resident was not being sent out as ordered, per the DON. This Note documented that the physician again ordered to send the resident out, but that the DON was calling a second doctor to discuss the resident's condition. This Note documented that the resident continued to complain of pain, and the swelling and bruising continued. A Nurse's Note of 12/12/2010 at 9:30 p.m. documented that the resident remained in the facility and that Tylenol had been administered for pain. A Nurse's Note of 12/13/2010 at 2:30 a.m. documented that no return call had been received from the second physician, and that the resident remained in the facility at that time, with the right arm continuing to be swollen and black. A Nurse's Note of 12/13/2010 at 7:30 a.m. documented the resident still remained in the facility at that time, that the wrist to elbow was dark purple, and that an X-ray was ordered. Further record review revealed that despite receiving two separate orders on 12/12/2010 specifying a hospital transfer for Resident #1, there was no evidence to indicate that the resident had been transported to the hospital as ordered. During interview with the Administrator at 1:30 p.m. on 01/24/2011, it was acknowledged that the nurse was given physician's orders twice to send the resident to the hospital and that the orders were not followed.", "filedate": "2014-04-01"}
{"rowid": 10533, "facility_name": "HARALSON NSG & REHAB CENTER", "facility_id": 115431, "address": "315 FIELD STREET", "city": "BREMEN", "state": "GA", "zip": 30110, "inspection_date": "2009-08-26", "deficiency_tag": 225, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "FH9411", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview the facility failed to ensure that injuries of unknown origin and allegations of abuse were immediately reported to the facility Administrator and to the State survey and certification agency, and that these allegations were thoroughly investigated for two residents (#1 and \"A\") of twenty four (24) sampled residents. Findings include: 1. Observation of resident #1 on 8/25/09 at 3:20 p.m. during a skin assessment revealed that Certified Nursing Assistants (CNA) \"AA\" and \"BB\" identified that the resident had an extensive, deep purple bruise between the fourth and fifth toe on the right foot. It extended behind the toes on the bottom of the foot and on the top of the foot. The CNA's indicated that they did not know how or when this injury occurred. They added that they discovered the bruise while getting the resident out of bed yesterday (8/24/09) and reported it to Licensed Practical Nurse (LPN) \"DD\" as soon as it was discovered. Record review revealed that there was no mention of the bruise in the nurses notes for 8/24/09. LPN \"CC\", the Unit Manager, located a Nurse/Physician Communication Record dated 8/24/09 included documentation of \"Client has bruised area to right little toe area, ran over toe when rolling in wheel chair\". This Communication Record was signed by LPN \"DD\". A telephone interview with LPN \"DD\"on 8/25/09 at 4:50 p.m. revealed that he had not witnessed the event but had been told by the Risk Manager that she had witnessed the event. An interview with the Risk Manager on 8/25/09 at 5:05 p.m. revealed that she had seen the resident with his foot behind the wheel of the wheelchair mid-morning on 8/24/09. She was aware that the CNA's had discovered the bruise before the resident got up for the morning on 8/24/09. She added, that she did not witness the resident's foot being run over with the wheel chair and acknowledged that this was an unwitnessed injury of unknown origin that should have been reported to the State agency and investigated. 2. Review of the clinical record for resident \"A\", who was assessed on the Minimum Data Set ((MDS) dated [DATE] as cognitively intact, revealed a Nurses' Note dated 7/21/09 at 3:30 p.m. which documented the resident went to the nurses' station and reported she sustained a skin tear during an incontinent episode in the resident's bathroom. The note also referred to the discovery of a large skin tear to the lower left outer leg which was treated. A Nurse/Physician Communication Record dated 7/21/09 documented the resident received a large skin tear during a transfer. Further review of the record revealed a Post-Incident 72-Hour Follow-up record that described the incident by documenting the resident came to the desk stating \"that boy grabbed my leg and pulled the hide off of it\". The Director of Nursing (DON) was interviewed on 8/26/09 at 2:15 p.m. and stated she interviewed the Certified Nursing Assistant (CNA) the following day who assisted the resident and he was not aware an injury had occurred while he was assisting her, but stated it was possible when he picked up her legs to clean the floor. The DON was not aware of the documentation on the 72-Hour Incident Follow-up Record, but stated she would have treated it as an allegation of abuse had it been reported to her. The Risk Manager was interviewed on 8/26/09 at 2:00 p.m. and the Unit Manager was interviewed at 8:20 a.m. that morning. Both stated they were not aware this statement had been made, but both agreed they would have considered it an allegation of abuse. Five different nursing staff members signed and documented assessments of the resident during the 72-Hour Follow-up and did not report the incident as possible abuse to anyone in administration.", "filedate": "2014-04-01"}
{"rowid": 10534, "facility_name": "HARALSON NSG & REHAB CENTER", "facility_id": 115431, "address": "315 FIELD STREET", "city": "BREMEN", "state": "GA", "zip": 30110, "inspection_date": "2009-08-26", "deficiency_tag": 279, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "FH9411", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff and resident interview the facility failed to develop a comprehensive care plan related to long-term symptoms affecting daily care for two (2) residents, (\"A\" and \"B\") of a sample of twenty-four (24) residents. Findings include: 1. During the initial tour conducted on 8/24/09 beginning at 11:00 a.m. the Unit Manager stated Resident \"A\" had difficulty swallowing and was going to have a procedure performed to stretch her esophagus. The Unit Manager further stated this difficulty had been a long term problem for the resident, but she had declined the procedure in the past. The resident, who was assessed as cognitively intact on the Minimum Data Set ((MDS) dated [DATE], stated she had difficulty swallowing, could only take small bites of food at a time, needed to have her throat stretched, and could not eat some foods during interviews on 8/24/09 at 1:05 p.m., 8/25/09 at 8:05 a.m. and 12:50 p.m. and 5:50 p.m. and again on 8/26/09 at 7:50 a.m. These conversations took place during meals in the main dining room. Each time the resident explained her difficulty and either was eating very little or asking for alternates. The Dietary Manager was interviewed on 8/26/09 at 11:00 a.m. and stated she was aware of the resident's problem with swallowing. She further stated, the resident's weight had been stable over the past year and that the resident would ask for foods that she could comfortably eat and that she frequently asked for alternates. Review of the Comprehensive Care Plan for the resident did not reveal any problem related to eating patterns or difficulty swallowing. The Care Plan Coordinator was interviewed on 8/26/09 at 9:05 a.m. She acknowledged she had not included this problem. 2. Record review for resident \"B\" revealed a current physician's orders [REDACTED]. According to the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. Review of resident's care plan did not identify a problem with itching that would require medication to be taken on a regular basis at night. Review of the pharmacist's monthly medication reviews did not reveal any indication of the use of the medication. In an interview on 8/26/09 at 9:00 a.m., the resident stated that they thought detergent used to wash the sheets caused the itching. In an interview with the Licensed Practical Nurse (LPN) \"TT\" on 8/26/09 at 1:10 p.m., she stated that the resident does not ask for [MEDICATION NAME] during the day and she was not aware of why the resident needed it. After reviewing the resident's care plan with LPN \"OO\" 1:15 p.m., she revealed that the resident had not been identified on the care plan for any problem that required the need of [MEDICATION NAME] at night on a frequent basis. In an interview with the Care Plan Coordinator on 8/6/09 at 1:30 p.m., she stated that a reason for the frequent use of [MEDICATION NAME] had not been discussed during the care plan meetings.", "filedate": "2014-04-01"}
{"rowid": 10535, "facility_name": "HARALSON NSG & REHAB CENTER", "facility_id": 115431, "address": "315 FIELD STREET", "city": "BREMEN", "state": "GA", "zip": 30110, "inspection_date": "2009-08-26", "deficiency_tag": 280, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "FH9411", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to update the Comprehensive Care Plan for one (1) resident, #3 of twenty-four (24) sampled residents related to the resident's desire to lose weight. Findings include: Review of the Comprehensive Care Plan for resident #3 revealed an update added 5/23/09 to a problem concerning the resident's risk for weight loss. The update revealed the resident actually desired to lose weight and that any weight loss would be planned and desired. However, the goals were not updated to reflect this and a current goal continued until the next review was to avoid significant weight loss. Review of interventions revealed the resident was also to continue receiving fortified foods twice a day. Review of the Minimum (MDS) data set [DATE] revealed the resident was on a planned weight change program. The Care Plan Coordinator and the Unit Coordinator were interviewed on 8/26/09 at 9:00 a.m. and both stated they were aware of the resident's desire to lose weight and acknowledged that the care plan was not revised with interventions to achieve this goal.", "filedate": "2014-04-01"}
{"rowid": 10536, "facility_name": "HARALSON NSG & REHAB CENTER", "facility_id": 115431, "address": "315 FIELD STREET", "city": "BREMEN", "state": "GA", "zip": 30110, "inspection_date": "2009-08-26", "deficiency_tag": 315, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "FH9411", "inspection_text": "Based on observation, record review and staff interview the facility failed to follow acceptable technique to prevent urinary tract infections during incontinent care for two (2) residents (#4 and #14) of twenty-four (24) sampled residents. Findings include: 1. On 8/25/09 at 9:30 a.m. Certified Nursing Assistant (CNA) \"GG\" was observed providing incontinence care to resident #4. The CNA used a perineal spray cleanser and washcloths. When the CNA cleaned the perineal area some of the perineal spray came in contact with the resident's skin. The resident protested . When the CNA turned the resident on her side to cleanse the anal area she wiped from the back to the front. Review of the facility's policy on Perineal Care revealed that washing should be performed from front to back. Review of the clinical record for this resident revealed laboratory reports dated 8/04/09 and 8/22/09 for urine cultures and sensitivities. Both revealed a urinary tract infection and the infecting organism was Escherichia coli. The resident was treated on both occasions with antibiotic therapy. 2. Record review for resident #14 revealed the resident was assessed on the 6/24/09 Minimum Data Set as being incontinent of bowel/bladder and as being dependent on staff for assistance of activities of daily living and as having a history of urinary tract infections. An observation on 8/24/09 at 4:00 p.m. revealed two Certified Nursing Assistants were leaving the resident's room. Certified Nursing Assistants (CNA) \"HH\" and \"II\" assisted the resident to the bathroom to provide incontinence care. A soiled brief was removed as the resident had been incontinent of bowel and bladder. Using a clean washcloth, the resident's perineal area was cleaned of feces by wiping one time with a back to front motion. A second clean washcloth was used to wipe the resident at mid perineum toward the back. The resident began urinating and was seated back on the toilet seat. Urine and a small amount of feces was noted on top of the toilet seat as the resident sat back down. Without cleaning the resident again, a white protective ointment was applied to the buttocks and a dry incontinent brief applied. Immediately following the delivery of incontinent care, CNA \"II\" stated in an interview that she did not see the urine or feces on the toilet seat before the resident was seated. The Director of Nursing (DON) was interviewed on 8/26/09 at 4:20 p.m. and stated proper incontinence care has been an ongoing problem.", "filedate": "2014-04-01"}
{"rowid": 10537, "facility_name": "HARALSON NSG & REHAB CENTER", "facility_id": 115431, "address": "315 FIELD STREET", "city": "BREMEN", "state": "GA", "zip": 30110, "inspection_date": "2009-08-26", "deficiency_tag": 325, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "FH9411", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to put interventions in place to address the protein needs of one (1) resident (#5) of twenty-four (24) sampled residents. Findings include: Review of the clinical record for resident #5 revealed blood was drawn on 7/30/09 to determine the resident's protein levels. The results of the test indicated the resident's [MEDICATION NAME] and [MEDICATION NAME] levels were below the normal range. The physician ordered a repeat test in eight (8) weeks and a nutrition consult with the Registered Dietician (RD). Review of the Nutritional Progress Notes revealed the RD completed the consult on 7/31/09. No new interventions were recommended to address the low protein levels. The RD documented interventions were already in place. Review of the clinical record revealed the resident had been on fortified foods at all meals since 5/22/09. Review of the resident's current Comprehensive Care Plan revealed a new problem added 8/10/09 addressing the resident's recent six (6) month significant weight loss of ten point five percent (10.5%). Although the family states the weight loss was desirable and put the resident at her usual weight, low [MEDICATION NAME] levels put the resident at risk if further weight is lost. The Care Plan did not address interventions to specifically address the low protein. The Unit Manager was interviewed on 8/26/09 at 8:40 a.m. and stated residents with nutritional risk are discussed at weekly Standards of Care (SOC) meetings. Review of the Nurses' Notes revealed the resident was discussed at these meetings on 8/03/09, 8/13/09 and 8/20/09. There were no interventions discussed at these meetings to address the protein levels. The Unit Manager stated the RD does not attend these meetings. Nutritional concerns are referred verbally to the dietician as needed. The Dietary Manager was interviewed on 8/2/609 at 6:30 p.m. She stated fortified foods do not contain added protein.", "filedate": "2014-04-01"}
{"rowid": 10538, "facility_name": "HARALSON NSG & REHAB CENTER", "facility_id": 115431, "address": "315 FIELD STREET", "city": "BREMEN", "state": "GA", "zip": 30110, "inspection_date": "2009-08-26", "deficiency_tag": 332, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "FH9411", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview the facility failed to maintain an error rate of less than five (5) percent. During observation of medication pass on 8/25/09 between 8:30 a.m. and 10:45 a.m. two (2) nurses were observed, during forty five (45) opportunities to pass medications. Four (4) errors were observed on one (1) of two (2) units resulting in a medication error rate of 8.88%. Findings include: 1. Licensed Practical Nurse (LPN) \"JJ\" administered two (2) puffs of [MEDICATION NAME] Multidose Inhaler to a resident. The second puff was administered ten (10) seconds after the first puff. In an interview with the LPN \"JJ\" at 8:40 a.m. she acknowledged that she should have waited two (2) minutes between puffs. A review of the facility's policy for administration of Oral Inhalations confirmed that two (2) minutes should elapse before administering the second puff. 2. LPN \"KK\" administered two (2) puffs of [MEDICATION NAME] Multidose Inhaler. The first and second puff was administered three (3) seconds apart. In an interview with this LPN she acknowledged that she should have waited at least one (1) minute between puffs. 3 & 4. Record review for the same resident revealed a physician's orders [REDACTED]. In an interview with LPN \"KK\" she confirmed that these two medications were omitted.", "filedate": "2014-04-01"}
{"rowid": 10539, "facility_name": "HARALSON NSG & REHAB CENTER", "facility_id": 115431, "address": "315 FIELD STREET", "city": "BREMEN", "state": "GA", "zip": 30110, "inspection_date": "2009-08-26", "deficiency_tag": 161, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "FH9411", "inspection_text": "Based on record review and staff interview, the facility failed to purchase a surety bond of sufficient value to assure the security of all resident trust funds deposited with the facility for 87 of 87 managed accounts. Findings include: Record review revealed the current surety bond was in the amount of $35,000.00. A review of bank statements for the Resident Trust Account revealed balances that exceeded this amount for the following months: 1. February 2009: 4 days were over the bond amount, the highest was $37,098.40 2. March 2009: 9 days over, the highest balance was $39,791.69 3. April 2009: 6 days over, the highest balance was $37,698.48 4. May 2009: The average daily balance was over the bond amount. 5. June 2009: The average daily balance was over the bond amount. 6. July 2009: The average daily balance was over the bond amount. Interview on 8/25/09 at 3:00 p.m. with the Business Office Manager revealed that she did not know the amount of the surety bond or that the account balance exceeded the bond amount.", "filedate": "2014-04-01"}
{"rowid": 10540, "facility_name": "HARALSON NSG & REHAB CENTER", "facility_id": 115431, "address": "315 FIELD STREET", "city": "BREMEN", "state": "GA", "zip": 30110, "inspection_date": "2009-08-26", "deficiency_tag": 365, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "FH9411", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview the facility failed to provide liquids and food prepared to the consistency ordered by the physician for one (1) resident (#17) of a sample of twenty-four (24) residents. Findings include: Observation of the lunch service on 8/26/09 at 12:55 p.m. revealed resident #17 was served two (2) bowls of chili for residents on a regular diet. Review of the resident's current Physician order [REDACTED]. The Dietary Manager was interviewed on 8/26/09 at 2:15 p.m. and confirmed that the resident should have been served the pureed chili. Observation on 8/25/09 at 9:15 a.m. during medication pass revealed that a medication nurse administered medications to resident #17 with liquids that were not thickened. Review of the August 2009 physician's orders [REDACTED]. Observation in the resident's room revealed an image of a bumble bee over the resident's bed. Interview with Licensed Practical Nurse (LPN) \"LL\" on 8/26/09 at 10:00 a.m. confirmed that the image of the bumble bee is a reminder to staff to provide thickened liquids to the resident. She added, that the medication nurse should have given the medications with thickened liquids.", "filedate": "2014-04-01"}
{"rowid": 10541, "facility_name": "HARALSON NSG & REHAB CENTER", "facility_id": 115431, "address": "315 FIELD STREET", "city": "BREMEN", "state": "GA", "zip": 30110, "inspection_date": "2009-08-26", "deficiency_tag": 456, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "FH9411", "inspection_text": "Based on observation and staff interview, the facility failed to maintain two (2) of two (2) microwave ovens and one (1) of two (2) refrigerators on two (2) of two (2) units. Findings include: During the observational tour of the facility conducted on 8/25/09 at 11:00 a.m. the following areas of concern were noted in two (2) of two (2) pantries. 1. Unit I- the microwave contained a build up of a black/brown substance on the back wall, and a chipped burned area on the top inside door. 2. Unit II- the microwave contained an accumulation of dried food particles/stains on the inside, and the plastic on the inside of the door was melted in two (2) areas. The inside of the refrigerator contained a moderate amount of water on the bottom shelf, the rubber seal around the door was torn, detached and had a build up of mold/mildew. Resident and staff food was being stored inside the refrigerator. The Administrator was made aware of these concerns during an interview on 8/25/09 at 6:30 p.m.", "filedate": "2014-04-01"}
{"rowid": 10542, "facility_name": "NEW HORIZONS LIMESTONE", "facility_id": 115487, "address": "2020 BEVERLY ROAD NE", "city": "GAINESVILLE", "state": "GA", "zip": 30501, "inspection_date": "2010-09-29", "deficiency_tag": 279, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "OSSL11", "inspection_text": "**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 (#3) and One (1) resident (#121) both who resided in \"B\" Building had a care plan developed of the continuous use of a hypnotic medication (#3) and a care plan based on assessment of positioning needs (#121). Findings include: Review of the current quarterly Minimum Data Set assessment ((MDS) dated [DATE] as well as the annual MDS assessment dated [DATE] recorded resident #3 as receiving a hypnotic medication seven (7) times a week during these assessment periods . Review of the current Physician order [REDACTED]. Review of past four (4) months of Medication Administration Records (June 2010, July 2010, August 2010 and September 2010) documented the resident was administered the medication every night. No care plan had been developed for the hypnotic medication with interventions for possible side effects or for interventions to implement alternate sleep pattern techniques. Interview with the Care Plan/MDS Nurse (staff \"BB\") on 9/28/10 at 11:20 a.m. revealed she had not done a care plan for the routine use of this resident's hypnotic medication. She usually included hypnotic medication use as part of the psychoactive medication care plan but had failed to do so for resident #3. Resident #121 was observed on 9/27/2010 at 12:25 p.m. in the main dining room sitting in a Broda chair waiting for lunch to be served. The resident was leaning to the right. Multiple staff members were present in the dining room but did not attempt to reposition the resident. The resident's lunch tray was served at 1:00 p.m. Certified Nursing Assistant ( CNA) \"ZZ\" fed the resident. \"Staff member \"ZZ\" made no attempt to reposition the resident to correct body alignment, but continued to feed the resident, whose head was resting on the staff member's shoulder. Review of the Comprehensive Care Plan did not identified any concerns with positioning. The Care Plan Coordinator was interviewed on 9/29/2010 at 1:25 p.m. and stated she was aware the resident leaned to the right when up in a chair and further stated multiple interventions had been tried but the resident refused all attempts and would become agitated and delusional when pillows/padding and other interventions were tried. The Care Plan Coordinator agreed the problem should have been care planned.", "filedate": "2014-04-01"}
{"rowid": 10543, "facility_name": "NEW HORIZONS LIMESTONE", "facility_id": 115487, "address": "2020 BEVERLY ROAD NE", "city": "GAINESVILLE", "state": "GA", "zip": 30501, "inspection_date": "2010-09-29", "deficiency_tag": 312, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "OSSL11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, resident and staff interview, the facility failed to consistently provide oral hygiene for one (1) totally dependent resident ('A') and one (1) resident ('B') who needed limited to extensive assistance with hygiene. Both residents resided in the \"B\" building. The total sample size was twenty-eight (28) residents. Findings include: 1. On 9/27/10 at 3:07 p.m., resident 'A' stated the staff didn't clean his/her teeth. The resident added that they would ask staff to help brush his/her teeth, but was usually told that they'd be back to do it, but they would never come back. He/she added that the last time they saw a dentist, the dentist said their teeth needed to be brushed every day. Review of the resident's Activities of Daily Living (ADL) care plan developed 7/25/10 noted the resident was dependent for all ADLs including bathing, grooming and hygiene due to [MEDICAL CONDITION] with multiple contractures, and interventions included to provide oral care every shift and as needed. A Dental Treatment/Exam document for resident 'A' dated 4/05/10 noted that the oral hygiene status included heavy plaque and heavy calculus and that oral hygiene needed improving, and recommended that the teeth must be brushed twice a day. The Certified Nursing Assistants' (CNA) ADL Notebook noted that the resident was dependent for teeth/mouth care. 2. On 9/28/10 at 10:45 a.m., resident 'B' stated that the staff only assisted him/her with oral hygiene weekly. They added that they usually had to ask the staff to assist them, because the staff didn't do it routinely. Review of the resident's ADL care plan developed 4/16/10 noted the resident needed limited to extensive assist with ADLs due to [MEDICAL CONDITION], and interventions included to assist with/provide mouth care every shift. On 9/29/10 at 9:00 a.m., the resident was noted to have paralysis of the left arm, and needed a wheelchair for mobility due to an amputation of the right leg. The resident stated they had upper and lower dentures, and was able to take them out and put them in the denture cup. He/she added that they could not open the Polident package with one hand, and that the staff would assist with this but only if he/she asked them to. Additionally, the resident stated that sometimes they forgot to ask, and may go a of couple days without taking his/her teeth out. On 9/29/10 at 11:40 a.m., CNA 'CC' stated that she thought resident 'B' had their own teeth, and could do their own oral care. She added that the CNAs had an ADL book that told them what the residents' care needs were. Later review of this ADL book noted that the resident did not have dentures, and that they needed assist with teeth and mouth care. Review of a Resident Admission Form dated 5/02/10 noted that the resident wore upper and lower dentures. On 9/29/10 at 12:52 p.m., the Director of Nurses stated that it was expected that oral care be part of the routine morning and evening care twice a day. The facility's Policy and Procedure on Mouth Care noted that residents will receive the appropriate care and services to ensure their comfort and well-being, and that mouth care will be provided by staff based on the resident's clinical condition.", "filedate": "2014-04-01"}
{"rowid": 10544, "facility_name": "NEW HORIZONS LIMESTONE", "facility_id": 115487, "address": "2020 BEVERLY ROAD NE", "city": "GAINESVILLE", "state": "GA", "zip": 30501, "inspection_date": "2010-09-29", "deficiency_tag": 371, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "OSSL11", "inspection_text": "Based on observation and staff interview the facility failed to store and serve food under sanitary conditions in \"B\" Building. This failure was evidenced by storing spoiled and unlabeled meat, and storing cooking, serving and eating utensils that have not been appropriately dried in one (1) of two (2) kitchens. Findings include: Observation of the kitchen on 9/27/10 between 10:30 a.m. to 12:00 p.m. with the Dietary Supervisor and the Patient Food Service Manager revealed the following concerns: The reach-in refrigerator had a clear container dated 9/08/10 that was approximately 1/3 full of sliced cooked meat. The container was not labeled with the type of meat. The meat had several spots of gray discoloration. The Dietary Supervisor acknowledged that the meat was spoiled and should be discarded. Dietary staff wrapping silverware that was still wet 4 of 6 soup bowls were stored wet 3 of 5 smaller soup bowls were stored wet 3 of 6 scoops in a draw were wet 2 of 5 serving utensils were in a draw wet Review of the facility's Nutrition Service Infection Control Guidelines revealed that food prepared and held refrigerated for more than 24 hours should be clearly marked with the date by which it must be served, which must be no more than seven (7) days.", "filedate": "2014-04-01"}
{"rowid": 10545, "facility_name": "BRIARCLIFF HAVEN HEALTHCARE AND REHAB CENTER", "facility_id": 115531, "address": "1000 BRIARCLIFF ROAD", "city": "ATLANTA", "state": "GA", "zip": 30306, "inspection_date": "2010-04-30", "deficiency_tag": 314, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "I73X11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview the facility failed to assess and provide treatments to pressure ulcers for one (1) resident (#235) of the sampled thirty-five (35) residents. Findings include: Review of the clinical record for resident #235, revealed that the resident was admitted to the facility on [DATE] at 12:14 p.m. with [DIAGNOSES REDACTED]. Review of the clinical record revealed no evidence that the pressure ulcers had been assessed by the facility staff, including staging and measuring, until 04/27/10, three days after admission. Review of the pressure ulcer assessment dated [DATE] revealed the following pressure ulcers: on the right buttock a Stage IV, five by three by two centimeter (5x3x2 cm) with tunneling; on the sacrum a Stage IV, 1x1x1 cm with tunneling; on the left heel an unstageable 2x2 cm, black color eschar pressure ulcer and on the right heel an unstageable 3x1 cm black color eschar covered pressure ulcer. Observation 04/29/10 at 2:39 p.m. of the identified pressure ulcer areas revealed the following: two (2) Stage IV pressure ulcers as assessed on 4/27/10 and one (1) Stage II. pressure ulcer to the left buttock that was previously not assessed. Observation and interview on 04/30/10 at 10:03 a.m. with Treatment Nurse \"HH\" revealed that the small area on the left buttock had not been staged or measured. The Treatment Nurse assessed the smaller area, revealing a 4x2 cm, Stage II pressure sore Review of the clinical record revealed a physician's order dated 4/23/10, for Dakins wet-to-dry dressings daily to the sacral pressure ulcers and [MEDICATION NAME] ointment to be applied topically every day. Review of the \"Treatment Administration Record\" (TAR) revealed that the sacral pressure ulcer was being treated with Dakins wet-dry dressing twice a day, [MEDICATION NAME] ointment was being applied topically every day but there was no evidence of where the [MEDICATION NAME] ointment was being applied. Observation on 04/29/10 at 2:39 p.m. of wound care for resident #235, performed by Treatment Nurse \"HH\" revealed that the nurse applied the [MEDICATION NAME] inside the sacral pressure ulcer and the right buttock pressure ulcer. Continued observation revealed that Treatment Nurse cleaned the wound with Saline and applied the Dakins wet-to dry gauze to the sacral wounds. The Treatment Nurse, then applied [MEDICATION NAME] to the left buttock pressure ulcer, although there was no physician order. Further observation revealed the resident had multipodus boots on both feet but the Treatment Nurse did not remove the multipodus boots for assessment and/or a treatment. Interview on 04/30/10 at 8:40 a.m. with Treatment Nurse \"HH\", revealed that the multipodus boots had not been removed and/or a treatment administered on 4/29/10. The Treatment Nurse indicated she had no knowledge of the wounds to the heels. Observation on 4/30/10 at 8:40 a.m. with Treatment Nurse \"HH\", revealed that when the left multipodus boot was removed the left heel had a black area. When the right heel multipodus boot was removed it revealed an unsecured dressing , without a date of application, and a pressure ulcer that was partially covered with eschar. Interview on 4/30/10 at 9:32 a.m. with Treatment Nurse \"GG\", revealed that both heels have eschar and are being treated with SafGel and a gauze dressing. Continued interview revealed that the treatments orders for the pressure ulcers were written on the hospital transfer orders. Interview on 04/30/10 at 10:03 a.m., with Treatment Nurse \"HH\", revealed that [MEDICATION NAME] ointment should not have been applied to the inside of the pressure ulcers but should have been only applied around the outside of the pressure ulcer areas.", "filedate": "2014-04-01"}
{"rowid": 10546, "facility_name": "BRIARCLIFF HAVEN HEALTHCARE AND REHAB CENTER", "facility_id": 115531, "address": "1000 BRIARCLIFF ROAD", "city": "ATLANTA", "state": "GA", "zip": 30306, "inspection_date": "2010-04-30", "deficiency_tag": 281, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "I73X11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to clarify a physician's order related to wound care and failed to follow the facility program related to weekly weights for two (2) residents (#15 and #235) of the sampled thirty-five (35) residents. Findings include: 1. Review of the clinical record for resident (#235) revealed physician's order dated 4/23/10, for [MEDICATION NAME] ointment to be applied topically every day. Review of the \"Treatment Administration Record\" (TAR) revealed that [MEDICATION NAME] ointment was being applied topically every day but there was no evidence of where the [MEDICATION NAME] ointment was being applied. Observation on 04/29/10 at 2:39 p.m. of wound care for resident #235, performed by Treatment Nurse \"HH\" revealed that the nurse applied the [MEDICATION NAME] inside the sacral pressure ulcer, the right buttock pressure ulcer and the left buttock pressure ulcer. Interview on 04/30/10 at 10:03 a.m., with Treatment Nurse \"HH\", revealed that the [MEDICATION NAME] ointment should not have been applied to the inside of the pressure ulcers but should have been applied on the outside of the pressure ulcer areas. The facility failed to clarify the use of the [MEDICATION NAME] ointment. 2. Review of the clinical record for resident #15 revealed the resident was admitted to the facility on [DATE] with a weight of one-hundred-ninety-six (196) pounds (lbs). Review of the weight history revealed that on 12/23/09 the resident weighed 186 lbs., which was a 10 lb. weight loss and/or a five percent (5%) weight loss in two (2) weeks. Further review revealed that the resident continued to lose weight, with the last recorded weight dated 4/6/10 at 170 lbs., thus a total weight loss of 26 lbs in four (4) months. Continued review of the clinical record revealed that on 4/06/2010 the resident was placed on a Weight Loss Risk Alert Program and Medals, a nutritional supplement, four (4) ounces three (3) times a day, then weekly weights for four (4) weeks to track the success or failure of the supplement. Interview on 4/30/2010 at 1:15 p.m. with the Registered Nurse Unit Manager, revealed that the resident had only been weighed once in the month of April, and not the weekly per the Weight Loss Risk Alert program. Review of the \"Georgia Registered Profession Nurse Practice Act\" revealed that \"Practice of nursing as a registered nurse\" means to perform for compensation any of the following: -Conducts a comprehensive nursing assessment that is an extensive data collection -Detects faulty or missing patient/client information -Provides appropriate monitoring Review of \"The practice of licensed practical nursing\" means the provision of care for compensation...which shall include, but not be limited to, the following: (A) Participating in the assessment, planning, implementation, and evaluation of the delivery of health care services", "filedate": "2014-04-01"}
{"rowid": 10547, "facility_name": "BRIARCLIFF HAVEN HEALTHCARE AND REHAB CENTER", "facility_id": 115531, "address": "1000 BRIARCLIFF ROAD", "city": "ATLANTA", "state": "GA", "zip": 30306, "inspection_date": "2010-04-30", "deficiency_tag": 156, "scope_severity": "B", "complaint": null, "standard": null, "eventid": "I73X11", "inspection_text": "Based on record review and staff interview, it was determined that the facility failed to include all of the required elements of the Medicare Denial notices issued for two (2) of three (3) residents reviewed. Findings include: Review of three (3) Medicare Denial notices that were issued to residents/family members revealed that notices failed to inform the residents of their right for an immediate appeal of the facility's determination and potential liability for payment of non-covered services in order to allow them to make an informed decision. Interview on 04/30/10 at 3:25 p.m. with Social Service Director (SSD), revealed that she is responsible for Medicare Denial Notices, using the Liability Beneficiary (LBN) Notices, Continued interview revealed that she does not issue the \"Skilled Nursing Facility Advanced Beneficiary Notice\" (CMS ), which informs the resident and/or responsible parties of an estimate of their cost if they decide to remain in the facility once skilled services are no longer needed.", "filedate": "2014-04-01"}
{"rowid": 10548, "facility_name": "BRIARCLIFF HAVEN HEALTHCARE AND REHAB CENTER", "facility_id": 115531, "address": "1000 BRIARCLIFF ROAD", "city": "ATLANTA", "state": "GA", "zip": 30306, "inspection_date": "2010-04-30", "deficiency_tag": 371, "scope_severity": "F", "complaint": null, "standard": null, "eventid": "I73X11", "inspection_text": "Based on observation and staff interview the facility failed to store food under sanitary conditions for all ninety-four (94) residents who consumed food orally. Findings include: Observation on 4/29/2010 at 11:00 a.m. of the dry storage area revealed the following: the lid for the sugar container was cracked and taped together with frayed duct tape; the lid for the thickener container was not on properly leaving a gap open on the top; the cornmeal was stored in a plastic bag in a bin with no lid and a portable compact disc player was on the top of the bin. Continued observation revealed the HVAC system, running the length of the kitchen, was coated in dust and there was dust observed in the grill cover on the front of the system. Interview on 4/29/10 at 11:00 a.m. with the Dietary Manager, revealed that the HVAC system was only used in the kitchen and they tried to keep it clean but were unable to remove the sticky substance and dust off the grill cover. During continued interview, the Dietary Manager acknowledged the food storage concerns.", "filedate": "2014-04-01"}
{"rowid": 10549, "facility_name": "BRIARCLIFF HAVEN HEALTHCARE AND REHAB CENTER", "facility_id": 115531, "address": "1000 BRIARCLIFF ROAD", "city": "ATLANTA", "state": "GA", "zip": 30306, "inspection_date": "2010-04-30", "deficiency_tag": 280, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "I73X11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to update the plan of care to address weight loss for one (1) resident (#15) of the sampled thirty-five (35) residents. Findings include: Review of the clinical record for resident #15, revealed the resident was re-admitted to the facility on [DATE]. Continue review of the clinical record revealed, a plan of care dated 12/2/09, that addressed the nutritional/hydration status and the potential for weight loss related to risk factors including age and need of assistance. Continued review of the clinical record revealed that the Dietary Manager (DM) had identified a weight loss of five (5) percent (%) or ten (10) pounds in two (2) weeks on 1/11/2010. The DM had recommended a dietary supplement be given twice a day and that the resident be weighed once a week for two (2) weeks. Further review revealed that a Quarterly Minimum Data Set (MDS) was completed on 3/10/10 but there was no evidence that the nutritional status of the resident had been updated to reflect the weight loss. The DM had clearly identified the significant weight loss in January and the weight records revealed a seventeen (17) pound weight loss since admission.", "filedate": "2014-04-01"}
{"rowid": 10550, "facility_name": "BRIARCLIFF HAVEN HEALTHCARE AND REHAB CENTER", "facility_id": 115531, "address": "1000 BRIARCLIFF ROAD", "city": "ATLANTA", "state": "GA", "zip": 30306, "inspection_date": "2010-04-30", "deficiency_tag": 325, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "I73X11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview the facility failed to ensure that interventions were implemented for a significant weight loss for one (1) resident (#15) of the sampled thirty-five (35) residents. Findings include: Observation on 4/29/2010 at 8:10 a.m. and 12:30 p.m. of the meals for resident #15, revealed the resident was served a regular diet with thin liquids and after set-up by staff was able to feed him/herself with supervision. Review of the clinical record revealed the resident was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Continued review revealed an admission weight of one-hundred-ninety-six (196) pounds (lbs) and the resident was seventy-four (74) inches tall. Review of the weight history revealed that on 12/23/09 the resident weighed 186 lbs., which indicated a ten (10) lb. weight loss and/or a five percent (5%) weight loss in two (2) weeks. Continued clinical record review revealed that the Dietary Manager (DM), assessed the significant weight loss on 1/11/2010 and recommended that a nutritional supplement be provided to the resident twice a day. Further review revealed no evidence that a nutritional supplement was ever physician ordered and/or administered to the resident. The resident continued to lose weight, with the last recorded weight dated 4/6/10 at 170 lbs., thus a total weight loss of 26 lbs in four (4) months. Interview on 4/30/2010 at 10:30 a.m. with the DM, revealed that there was no systematic method to assure that nursing or the physician had received recommendations for supplements. Interview on 4/29/2010 at 1:30 p.m. with Licensed Practical Nurse (LPN) \"AA\", acknowledged that prior to 4/06/10, the resident had not received nutritional supplements. Review of the clinical record revealed that on 4/06/2010 the resident was placed on a Weight Loss Risk Alert Program and Medals, a nutritional supplement, four (4) ounces was to be administered, three (3) times a day and weekly weights for four (4) weeks to track the success or failure of the supplement. The last recorded weight was dated 4/06/10 of 170 lbs. Interview on 4/30/2010 at 1:15 p.m. with the Registered Nurse Unit Manager, revealed that the resident had only been weighed once in the month of April, and not the weekly per the Weight Loss Risk Alert program", "filedate": "2014-04-01"}
{"rowid": 10551, "facility_name": "BRIARCLIFF HAVEN HEALTHCARE AND REHAB CENTER", "facility_id": 115531, "address": "1000 BRIARCLIFF ROAD", "city": "ATLANTA", "state": "GA", "zip": 30306, "inspection_date": "2010-04-30", "deficiency_tag": 157, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "I73X11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to ensure that the physician was notified of a change in condition related to weight loss for one (1) resident (#15) of the sampled thirty-five (35) residents. Findings include: Review of the clinical record weight history for resident #15, revealed a twenty-seven (27) pound weight loss since admission on 12/01/2009. Review of the January 2010, physician progress notes [REDACTED]. Interview on 4/30/2010 at 12:30 p.m. with the Nurse Consultant revealed that the physician was not aware of the weight loss until notified on 4/29/10.", "filedate": "2014-04-01"}
{"rowid": 10552, "facility_name": "BRIARCLIFF HAVEN HEALTHCARE AND REHAB CENTER", "facility_id": 115531, "address": "1000 BRIARCLIFF ROAD", "city": "ATLANTA", "state": "GA", "zip": 30306, "inspection_date": "2010-04-30", "deficiency_tag": 520, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "I73X11", "inspection_text": "Based on facility record review and staff interview, the facility failed to conduct the Quality Assurance Program with the required staff for three (3) of four (4) quarters. Findings include: Review of the Quality Assurance (QA) minutes, attendance sign in sheets for the last calendar year revealed that the Medical Director had attended only two (2) of the quarterly meetings and that one (1) of the quarterly meetings had been attended by only four (4) of the five (5) required staff members.. Interview on 04/30/10 at 1:30 p.m., with the Administrator, revealed that at a minimum, the Director of Nursing, Assistant Director of Nursing, Medical Director and the Administrator were in attendance at most of the Quarterly Meetings meetings throughout the year.", "filedate": "2014-04-01"}
{"rowid": 10553, "facility_name": "BRIARCLIFF HAVEN HEALTHCARE AND REHAB CENTER", "facility_id": 115531, "address": "1000 BRIARCLIFF ROAD", "city": "ATLANTA", "state": "GA", "zip": 30306, "inspection_date": "2010-04-30", "deficiency_tag": 278, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "I73X11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to ensure that the Minimum Data Set (MDS) assessment accurately reflected the status of one (1) resident (#15) of the sampled thirty-five (35) residents. Findings include: Review of the clinical record for resident #15, revealed a Comprehensive Minimum Data Set (MDS) was completed on 12/11/2009, which included a weight of one-hundred-ninety-six (196) pounds. Interview on 4/29/2010 at 1:20 p.m. with the MDS/Care Plan Nurse revealed that she was not familiar with this resident . She stated that they were short of help in the MDS office and had a temporary nurse helping her. Continued interview revealed that the resident had weight loss that was not identified. Review during the Quality Assurance Process revealed a Quarterly MDS had been completed on 3/10/10.. Review of the Quarterly MDS, dated [DATE] revealed, that resident #15, weighed 179 pounds. Continued review of the Quarterly MDS assessment, (Section \"K\", question number 3) revealed, that the weight status was coded incorrectly indicating that there had been no change in the weight of the resident.", "filedate": "2014-04-01"}
{"rowid": 10554, "facility_name": "BRIARCLIFF HAVEN HEALTHCARE AND REHAB CENTER", "facility_id": 115531, "address": "1000 BRIARCLIFF ROAD", "city": "ATLANTA", "state": "GA", "zip": 30306, "inspection_date": "2010-04-30", "deficiency_tag": 514, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "I73X11", "inspection_text": "Based on record review and staff interview the facility failed to ensure that the clinical record contained sufficient information including a Quarterly Minimum Data Set (MDS) assessment for one (1) resident (#15) of the sampled thirty-five (35) residents. Findings include: Review of the clinical record for resident #15, revealed that a Comprehensive MDS was completed on 12/11/2009. There was no evidence in the clinical record that a required Quarterly MDS due in March 2010 had been completed. Interview on 4/29/2010 at 1:20 p.m. with the MDS/Care Plan Nurse revealed that they were short of help in the MDS office and had a temporary nurse helping her. She acknowledged that the resident should have been assessed in March but it had not been done. Review during the Quality Assurance Process revealed a Quarterly MDS had been completed on 3/10/10 but there was no evidence in the clinical record of the assessment and the MDS/Care Plan Nurse was not aware that an assessment had been completed.", "filedate": "2014-04-01"}
{"rowid": 10555, "facility_name": "JONESBORO NURSING AND REHABILITATION CENTER", "facility_id": 115545, "address": "2650 HIGHWAY 138 SE", "city": "JONESBORO", "state": "GA", "zip": 30236, "inspection_date": "2009-07-22", "deficiency_tag": 371, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "LY2811", "inspection_text": "Based on observations , staff interviews, and the facility inservice records, the facility failed to ensure that dietary staff wore the proper facial hair restraint. Findings include: Observation on 7/20/09 at 1:00 pm and 1:45 pm, revealed a male dietary staff walking around in the kitchen area with the beard restraint hanging around his neck, under his chin. He was observed standing over food near the serving line area, talking to staff. During an interview with Dietary Staff \"CC\" on 7/20/09 at 1:47 pm, it was revealed that the dietary male staff should had been wearing a hair restraint.. Interview on 7/20/09 at 2:50 pm with the Registered Dietian \"DD\" revealed that the dietary staff should be wearing beard restraints over facial areas. A review of the Dietary Monthly Inservice Record held on 5/26/09 revealed that all hair must be covered including beard and mustaches with hair restraints. Further review revealed documented evidence that the dietary staff member had attended this particular inservice.", "filedate": "2014-04-01"}
{"rowid": 10556, "facility_name": "JONESBORO NURSING AND REHABILITATION CENTER", "facility_id": 115545, "address": "2650 HIGHWAY 138 SE", "city": "JONESBORO", "state": "GA", "zip": 30236, "inspection_date": "2009-07-22", "deficiency_tag": 315, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "LY2811", "inspection_text": "Based on a review of the Resident Census and Condition report, facility's policy/procedure for Bladder Retraining, Bowel and Bladder Elimination Pattern Assessment tool, resident and staff interviews, the facility failed to restore/maintain as much normal bladder function for one (1) resident ( \"Y\" ) from a sample of twenty four (24) residents. Findings include: During an interview with resident \"Y\" on 7/21/09 at 10:30 am, revealed that she was continent during the day but uses a brief at night. She further revealed that she occasionally has accidents if she does not get to the toilet fast enough. She indicated that the Certified Nursing Assistants ( CNAs) check and change her when she wears the briefs at night. During a review of the admission MDS ( Minimum Data Set ) assessment for resident \"Y\" dated 8/20/08, and quarterly assessments dated 1/16/09 and 7/1/09 revealed the resident was assessed as being continent of bladder but required extensive assistance with transfers. Record review revealed a Bladder Elimination Assessment form dated 3/7/08 through 3/13/08, which was to determine the resident's bladder function/toileting schedule, was incomplete. A review of the facility policy/procedure for Bladder Independence/Retraining that was in effect since 11/03 revealed the following criteria: Assess the resident for factors that would create difficulty for the resident to toilet safely. Establish interventions to meet individual resident's goals. Maintain a voiding schedule that is based on the resident's voiding assessment Further record review revealed the facility had failed to follow their policy/procedure to assess/maintain this residents' bladder function. Interview with the Director of Nursing (DON) on 7/22/09 at 11:15am revealed that the facility had continued to use a three (3) day voiding and bowel assessment for residents on admission. She further revealed that the last assessment for a resident for a bowel and bladder program was October 2008. There are no residents currently on a Bowel and Bladder Retraining Program. A review of the Resident Census and Condition revealed that the facility had sixty-three ( 63) residents that were occasionally/frequently incontinent of bladder but no one is on a bladder retraining program. Interview with the Administrator on 7/22/09 at 2:50pm revealed that the facility prevalence of occasional/frequent bladder incontinence without a toileting plan flagged at a 100% and that the facility was waiting on a new assessment tool from corporate.", "filedate": "2014-04-01"}
{"rowid": 10557, "facility_name": "JONESBORO NURSING AND REHABILITATION CENTER", "facility_id": 115545, "address": "2650 HIGHWAY 138 SE", "city": "JONESBORO", "state": "GA", "zip": 30236, "inspection_date": "2009-07-22", "deficiency_tag": 356, "scope_severity": "B", "complaint": null, "standard": null, "eventid": "LY2811", "inspection_text": "Based on observations and review of the facility posted staffing data forms, the facility failed to post the daily census for three (3) days of the survey (7/20/09 through 7/22/09). Findings include: Observations of the staffing data forms posted on 7/20/09 through 7/22/09, at 1:00pm each day, revealed no resident census posted on the staffing data form.", "filedate": "2014-04-01"}
{"rowid": 10558, "facility_name": "JONESBORO NURSING AND REHABILITATION CENTER", "facility_id": 115545, "address": "2650 HIGHWAY 138 SE", "city": "JONESBORO", "state": "GA", "zip": 30236, "inspection_date": "2009-07-22", "deficiency_tag": 469, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "LY2811", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident and staff interviews, the facility failed to ensure that one (1) resident ( \"Z\" ) from a sample of twenty-four (24) residents was free of pests. Findings include: Observation on 7/22/09 at 8:15 am revealed tiny insects crawling on resident \"Z's \" right hand and lower part of arm. Further observation revealed tiny insects crawling on the resident's bed on the right side rail and on the call light. Further observation at 8:30 am revealed tiny insects crawling on a bottle of baby powder on the bedside table near the resident's bed and the insects were crawling on the call light cord from the wall to the bed. During an interview with charge nurse \"EE\" on 7/20/09 at 8:30 am, revealed that the tiny insects were ants and that the ants were also on the bedside table. During an interview with resident \"Z\" on 7/20/09 at 9:00 am revealed that the resident had problems with ants before in the past, but has never been bitten. She further indicated that she has never had ants on her or in her bed before. Interview with maintenance staff \"GG\" on 7/22/09 at 9:35 am revealed that there had been no problens in this room with ants, however; ants had been a problem in resident room 128 in the past. A review of the pest management invoice dated 7/15/09 revealed resident room 128 was treated for [REDACTED]. Further interview with maintenance staff \"GG\" on 7/22/09 at 3:15 pm revealed that the Pest Control Company had determined that the ants in resident's \"Z\" room were coming in from the outside due to a crack in the wall near the air conditioner unit.", "filedate": "2014-04-01"}
{"rowid": 10559, "facility_name": "RIVER TOWNE CENTER", "facility_id": 115566, "address": "5131 WARM SPRINGS RD", "city": "COLUMBUS", "state": "GA", "zip": 31909, "inspection_date": "2010-12-10", "deficiency_tag": 365, "scope_severity": "K", "complaint": null, "standard": null, "eventid": "WE6B11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility records, resident medical records review, interviews with family, emergency medical technicians, and staff, it was determined the facility failed to provide food in a form that met the individual needs of six (6) sampled residents (\"A\", #2, #3, #4, #6 and #7) of 13 sampled residents. This failure resulted in serious harm (death) for Resident \"A\" and had a high potential for serious harm for the five sampled residents who had orders for ground meat diets or house ground diets that were reviewed. Additionally, further residents were identified at risk based on review of the Centers for Medicare and Medicaid Services (CMS), Form 672, that denoted 65 residents in the facility required mechanically altered diets, either pureed or all chopped food. Of these 65, according to review of the facility's Diet Listing, 52 residents required gound meat and/or foods, thus all 52 of these residents would be at potential risk for serious harm. It was determined that an immediate and serious threat to resident health and safety existed as of 10/30/10 and was removed on 12/09/10, at which time a plan was implemented by the facility to remove the immediate jeopardy situation. Findings include: A review of the facility's Saturday Week #3 Fall-Winter Menus revealed that on October 30, 2010, the planned supper menu for residents receiving regular diets listed the meat being served as beef tips over noodles. For the ground diets, the meat was to be three ounces of ground beef tips. On December 7, 2010, the Tuesday Week #1 Fall-Winter Menus had a planned supper menu of homemade beef stew listed as the meat for regular diets. The menu for \"ground\" consistency read 6 ounces (soft veggies) and did not denote the amount nor the consistency of meat to be served. The Registered Dietician stated during an interview on 12/10/10 at 3:00 p.m., that since 12/8/10, she had revised the menu for homemade beef stew, for ground diets, to read 6 ounces of ground meat with soft veggies. She stated that a typographical error had been made on the original menu, in that the ground meat had been left off of the menu for homemade beef stew, for the ground diets. A record review was conducted and revealed Resident \"A\" was admitted to the facility on [DATE]. The speech therapist's notes of 10/9/10 documented that the resident had poor safety awareness, poor attention to task and poor orientation. The resident was on a regular diet on the initial admission to the facility. The resident was admitted to the hospital on [DATE], with a [DIAGNOSES REDACTED]. An interview with the family of the resident on 11/10/10 at 4:10 p.m. revealed that while the resident was in the hospital he had received a diet of ground consistency. He was readmitted to the facility on [DATE] with a physician's orders [REDACTED]. Despite the physician's orders [REDACTED]. The facility served beef tips and noodles, that had chunks of meat that were not ground served to residents. The facility failed to provide the form of meat that was ordered. A review of documentation in Resident \"A's\" nursing notes, dated 10/30/10 at 6:40 p.m., revealed the licensed staff person documented that she had been called to the resident's room at that time by a certified nursing assistant (CNA). The resident was found unresponsive in bed. Cardiopulmonary Resuscitation was initiated. The nurse documented that 911 was called at 6:42 p.m.. According to the emergency trip report of 10/30/10, emergency medical technicians arrived to the facility at 6:45 p.m. to transport the resident to the hospital and provide emergency care. The trip report documentation revealed that the resident's airway was obstructed and large chunks of food were suctioned out of the airway. On 12/7/10 at 2:45 p.m., interview with an emergency medical technician revealed that the resident's airway was blocked by what looked like chunks of beef. Interview with the family member of Resident \"A\" on 11/10/10 at 4:10 p.m. revealed the following information. When the family member got to the hospital on the night of 10/30/10, she was told by the physician that the resident had aspirated food and that the food had been packed in his esophagus. She stated that she was told that the emergency medical technicians had suctioned food out of the resident's airway en route to the hospital. The resident later expired on 10/31/10 at 12:56 p.m. in the hospital with a [DIAGNOSES REDACTED]. 2. Resident #2 was observed on 12/07/10 during supper between 5:52 p.m. and 6:20 p.m. to have been served a diet of beef stew which contained whole pieces of beef; however, the diet order for this resident was for regular/ground. The resident had a 11/10/10 plan of care for dysphasia with an intervention to provide the resident with the appropriate diet and consistency. 3. Resident #3 was observed on 12/07/10 during supper between 5:52 p.m. and 6:20 p.m. to have been served a diet with whole pieces of beef in the stew; however, the diet order for this resident was for a house/ground diet. The resident was observed at that time and date to have missing front teeth. 4. Resident #4 was observed on 12/07/10 during supper between 5:52 p.m. and 6:20 p.m. to have been served a diet with whole pieces of beef in the stew; however, the resident's diet order was for house/ground diet with large portions. The resident had a [DIAGNOSES REDACTED]. 5. Resident #6 was observed on 12/07/10 during supper between 5:52 p.m. and 6:20 p.m. to have been served a diet with whole pieces of beef in the stew; however, the resident's diet order was for house/ ground meat. 6. Resident #7 was observed on 12/07/10 during supper between 5:52 p.m. and 6:20 p.m. to have been served a diet with whole pieces of beef in the stew; however, the resident's diet order was for house/ground meat. The resident had a 10/07/10 plan of care related to difficulty swallowing with an intervention to provide the therapeutic diet plan as ordered per the physician. During an interview with the Registered Dietician on 12/8/10 at 4:10 p.m., said that for any residents with a ground meat diet, all meat should be in ground consistency. She further stated that a typographical error had been made on the original menu, in that the ground meat had been left off of the menu for homemade beef stew, for the ground diets. Cross refer to F361. Based on the above, Resident \"A\" had a physician's orders [REDACTED]. On 10/30/2010, Resident \"A\" was served beef tips with chunks of meat which were not ground, was later found unresponsive, and required the initiation of Cardiopulmonary Resuscitation and notication of EMS. The resident's airway was found to be obstructed with large chunks of food, which were described as having the appearance of beef chunks, suctioned out of the airway. The resident later expired. Despite this fact, during the survey, five (5) residents who had physicians' orders specifying food of a ground consistency were served whole pieces of beef in beef stew. An immediate and serious threat to resident health and safety was determined to be removed on December 9, 2010, when the facility completed the following steps: With respect to all residents who may be affected: a. On 12/08/10, the Regional Director for Nutritional Services re-educated the center's Dietary Manager and Registered Dietician on proper food form and menu consistency. b. On 12/08/10, training was begun for dietary employees who were on duty regarding re-education on how to prepare and serve resident meals with the emphasis on meat food form based upon the The New England Diet Manual for Extended Care. c. On 12/08/10, training was begun regarding any dietary employee not on duty regarding re-education over the telephone by the center's Registered Dietitian. No employee in dietary who was initially trained by telephone will be allowed to report to duty until also re-educated in person on proper food form and following menus by the Registered Dietician. d. On 12/08/10, training was begun for all nursing staff, to include licensed nursing staff and certified nursing staff, regarding re-education on proper food form and following tray cards. No nursing employee will be allowed to return to duty until re-educated on proper food form, and a manager will be stationed at the employee time clock to ensure that no nursing employee reports to duty until re-educated. e. On 12/08/10, the Regional Director of Nutritional Services reviewed the center's menus with the Dietary Manager and Registered Dietician to ensure that proper food form was prepared as indicated by the menus, and any menu that was confusing was revised and/or eliminated immediately to ensure the proper food form. f. On 12/08/10, the Registered Dietician has reviewed the diet orders of all residents in the center for the appropriate food form. g. On 12/08/10, the Dietary Manager validated the resident diet orders against the residents' tray cards for the proper food form. With respect to ongoing systemic measures: a. On 12/08/10, the dietary manager or a cook began the process of checking each tray on the tray line to ensure each diet food form is prepared correctly per the menu and will document the findings in the tray line audit tool. b. On 12/08/10, a licensed nurse or certified aide began the process of checking each tray before it is served for the proper food form and will document the findings on the audit tool. c. On 12/08/10, the Regional Director of Nutritional Services will review, on a quarterly basis, the center's menus with the Dietary Manager and Registered Dietician to ensure the proper food form and menu is prepared as indicated by the menus. d. On 12/08/10, any menu that is confusing will be revised or eliminated immediately to ensure the proper food form. e. On 12/08/10, upon admission and readmission of a resident at the center the Licensed Nurse will validate with the admitting physician the proper food form for the resident on the diet order. With respect to quality assurance measures: a. On 12/08/10, an Ad hoc Performance Improvement Meeting was held with the Medical Director to discuss and further develop the plan related to proper food form and education of the staff. This will be presented at the next Performance Improvement Committee meeting scheduled for Wednesday, December 15, 2010. b. On 12/08/10, the center's administrator will begin reviewing the audit tools three times per week for four weeks, then as determined by the Performance Improvement Committee. Even though the facility had implemented the interventions referenced above, a determination could not be made that the facility had implemented an ongoing plan to ensure that the facility's system for providing the correct food form, and for the monitoring of residents' ordered diets, was effective. Therefore, the non-compliance continues, but the scope and severity level is reduced to an \"E\" level.", "filedate": "2014-04-01"}
{"rowid": 10560, "facility_name": "RIVER TOWNE CENTER", "facility_id": 115566, "address": "5131 WARM SPRINGS RD", "city": "COLUMBUS", "state": "GA", "zip": 31909, "inspection_date": "2010-12-10", "deficiency_tag": 361, "scope_severity": "K", "complaint": null, "standard": null, "eventid": "WE6B11", "inspection_text": "Based on review of facility records, review of resident medical records, observations, and staff interviews, the facility failed to ensure that menus for residents having physicians ' orders for ground consistency specified the amount and consistency of meat to be served, and failed to ensure that staff were knowledgeable about proper procedures for food preparation and service regarding food form, for five (5) residents (#s 2, 3, 4, 6 and 7), who had physicians ' orders for ground meat diets or house ground diets, of thirteen (13) sampled residents. This failure resulted in a high potential for serious harm for these five (5) sampled residents. Further, residents were identified at risk based on review of the Centers for Medicare and Medicaid Services Form 672, which denoted that sixty-five (65) residents required mechanically altered diets, either pureed or all-chopped food. According to review of the facility ' s Diet Listing, fifty-two (52) of these sixty-five (65) residents required ground meat and/or foods, thus placing all fifty-two (52) residents at potential risk for serious harm. It was therefore determined that an immediate and serious threat to resident health and safety existed as of 10/30/2010, and was removed on 12/09/2010, at which time a plan was implemented by the facility to remove the immediate jeopardy situation. Findings include: A review of the facility's Saturday Week #3 Fall-Winter Menus revealed that on October 30, 2010, the planned supper menu for residents receiving regular diets listed the meat being served as beef tips over noodles. For the ground diets, the meat was to be three ounces of ground beef tips. On December 7, 2010, the Tuesday Week #1 Fall-Winter Menus had a planned supper menu of homemade beef stew listed as the meat for regular diets. The menu for \"ground\" consistency read 6 ounces (soft veggies) and did not denote the amount nor the consistency of meat to be served. Interview with dietary staff \"AA\" on 12/8/10 at 4:35 p.m. revealed that she had prepared the evening meal on 12/7/10. She stated that when she saw the breakdown of the \"ground\" diet menu for this meal on this date, she was not sure how to prepare the meat for this diet, since the menu did not specify what consistency the meat should be. She said she asked the Dietary Manager if the meat should be ground since the menu just said soft vegetables and he told her he was not sure either, and just to serve the meat in the stew whole. She stated that she had never heard of a dietetic manual or was not aware of how to utilize this manual till today. The Registered Dietician stated on 12/8/10 at 4:10 p.m., that for any resident with a ground meat diet order, all meat should be in ground consistency. The facility's New England Diet Manual for Extended care documented that whole pieces of meat should be avoided for \"ground\" diets. The Registered Dietician stated during an interview on 12/10/10 at 2:30 p.m., that since 12/8/10, she had revised the menu for homemade beef stew, for ground diets, to read 6 ounces ground meat with soft veggies. She stated that a typographical error had been made on the original menu, in that the ground meat had been left off of the menu for homemade beef stew for the ground diets. Resident #2 was observed on 12/07/10 during supper between 5:52 p.m. and 6:20 p.m. to have been served a diet of beef stew which contained whole pieces of beef; however, the diet order for this resident was for regular/ground. Resident #3 was observed on 12/07/10 during supper between 5:52 p.m. and 6:20 p.m. to have been served a diet with whole pieces of beef in the stew; however, the diet order for this resident was for a house/ground diet. Resident #4 was observed on 12/07/10 during supper between 5:52 p.m. and 6:20 p.m. to have been served a diet with whole pieces of beef in the stew; however, the resident's diet order was for house/ground diet with large portions. Resident #6 was observed on 12/07/10 during supper between 5:52 p.m. and 6:20 p.m. to have been served a diet with whole pieces of beef in the stew; however, the resident's diet order was for house/ ground meat. Resident #7 was observed on 12/07/10 during supper between 5:52 p.m. and 6:20 p.m. to have been served a diet with whole pieces of beef in the stew; however, the resident's diet order was for house/ground meat. Refer to additional information at F365. An immediate and serious threat to resident health and safety was determined to be removed on December 9, 2010, when the facility completed the following steps: With respect to all residents who may be affected: a. On 12/08/10, the Regional Director for Nutritional Services re-educated the center's Dietary Manager and Registered Dietician on proper food form and menu consistency. b. On 12/08/10, training was begun for dietary employees who were on duty regarding re-education on how to prepare and serve resident meals with the emphasis on meat food form based upon the The New England Diet Manual for Extended Care. c. On 12/08/10, training was begun regarding any dietary employee not on duty regarding re-education over the telephone by the center's Registered Dietitian. No employee in dietary who was initially trained by telephone will be allowed to report to duty until also re-educated in person on proper food form and following menus by the Registered Dietician. d. On 12/08/10, training was begun for all nursing staff, to include licensed nursing staff and certified nursing staff, regarding re-education on proper food form and following tray cards. No nursing employee will be allowed to return to duty until re-educated on proper food form, and a manager will be stationed at the employee time clock to ensure that no nursing employee reports to duty until re-educated. e. On 12/08/10, the Regional Director of Nutritional Services reviewed the center's menus with the Dietary Manager and Registered Dietician to ensure that proper food form was prepared as indicated by the menus, and any menu that was confusing was revised and/or eliminated immediately to ensure the proper food form. f. On 12/08/10, the Registered Dietician has reviewed the diet orders of all residents in the center for the appropriate food form. g. On 12/08/10, the Dietary Manager validated the resident diet orders against the residents' tray cards for the proper food form. With respect to ongoing systemic measures: a. On 12/08/10, the dietary manager or a cook began the process of checking each tray on the tray line to ensure each diet food form is prepared correctly per the menu and will document the findings in the tray line audit tool. b. On 12/08/10, a licensed nurse or certified aide began the process of checking each tray before it is served for the proper food form and will document the findings on the audit tool. c. On 12/08/10, the Regional Director of Nutritional Services will review, on a quarterly basis, the center's menus with the Dietary Manager and Registered Dietician to ensure the proper food form and menu are prepared as indicated by the menus. d. On 12/08/10, any menu that is confusing will be revised or eliminated immediately to ensure the proper food form. e. On 12/08/10, upon admission and readmission of a resident at the center, the Licensed Nurse will validate with the admitting physician the proper food form for the resident on the diet order. With respect to quality assurance measures: a. On 12/08/10, an Ad hoc Performance Improvement Meeting was held with the Medical Director to discuss and further develop the plan related to proper food form and education of the staff. This will be presented at the next Performance Improvement Committee meeting scheduled for Wednesday, December 15, 2010. b. On 12/08/10, the center's administrator will begin reviewing the audit tools three times per week for four weeks, then as determined by the Performance Improvement Committee. Even though the facility had implemented the interventions referenced above, a determination could not be made that the facility had implemented an ongoing plan to ensure that the facility's system for providing the correct food form, and for the monitoring of residents' ordered diets, was effective. Therefore, the non-compliance continues, but the scope and severity is reduced to an \"E\" level.", "filedate": "2014-04-01"}
{"rowid": 10561, "facility_name": "PINEWOOD NURSING CENTER", "facility_id": 115607, "address": "433 NORTH MCGRIFF STREET", "city": "WHIGHAM", "state": "GA", "zip": 39897, "inspection_date": "2010-12-01", "deficiency_tag": 253, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "YYPJ11", "inspection_text": "Based on observation, resident interview, and staff interview, it was determined that the facility had failed to maintain an orderly environment on one (1) hall (200 hall) of two (2) halls observed. The findings include: During interview with Resident \"A\" conducted on 12/01/2010 at 2:30 p.m., the resident stated that there were leaks in rooms 209, 208 and 207. Observations of rooms 210, 209, 208 and 207 on 12/01/2010 at 3:45 p.m. revealed the following: 1. In room 210, there was a stained, wet and bulging ceiling tile over the lavatory. 2. In room 209, there were two missing ceiling tiles over where the \"A\" bed should have been. The insulation in the ceiling was saturated and a dark substance was observed in the area around the wet insulation. There was a large bedspread on the floor under this area. 3. In room 208, there was a missing ceiling tile over the bedside table at the \"A\" bed. The ceiling tiles around this area were soaked and bulging. 4. In room 207, there were bulging and wet ceiling tiles at the fluorescent light at the foot of the \"A\" bed and in front of the closets. During an interview with the Assistant Maintenance Director, who had worked at the facility since August of 2009, he stated that there had been leaks on the 200 hall since he had been at the facility. Some of the leaks had been in rooms 207 and 212. He provided a current receipt, dated 11/17/10, for Lexel to fix the leaks in the rooms on the 200 hall. He stated that he had used such things as Lexel, Mastic and other caulking to try to repair the leaks in these rooms and on this hall, however, these measures had only fixed the leaks temporarily.", "filedate": "2014-04-01"}
{"rowid": 10562, "facility_name": "PINEWOOD NURSING CENTER", "facility_id": 115607, "address": "433 NORTH MCGRIFF STREET", "city": "WHIGHAM", "state": "GA", "zip": 39897, "inspection_date": "2010-12-01", "deficiency_tag": 312, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "YYPJ11", "inspection_text": "Based on observation, record review, and staff interview, it was determined that the facility failed to ensure the provision of the appropriate incontinence care for one (1) resident (#5) from a survey sample of five (5) residents. Findings include: Record review for Resident #5 revealed the resident's Care Plan of 10/26/2010 indicated that the resident was totally dependent on staff for all activities of daily living care, including incontinence care. During an observation of incontinence care for Resident #5 at 12:35 p.m. on 12/01/2010, two (2) certified nursing assistants (CNAs) initially cleaned the resident with a disposable blue pad that had been dampened with water. However, these CNAs failed to wash any portion of the resident's penis. It was observed that the resident had been incontinent of urine. Licensed Staff \"AA\" was in the room during this observation and acknowledged that this incontinence care was not performed appropriately.", "filedate": "2014-04-01"}
{"rowid": 10563, "facility_name": "PINEWOOD NURSING CENTER", "facility_id": 115607, "address": "433 NORTH MCGRIFF STREET", "city": "WHIGHAM", "state": "GA", "zip": 39897, "inspection_date": "2010-12-01", "deficiency_tag": 225, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "YYPJ11", "inspection_text": "Based on facility document review, it was determined that the facility had failed to report allegations of neglect and mistreatment to the State survey and certification agency for one (1) resident (#1) from a survey sample of five (5) residents. Findings include: A 10/29/2010 facility complaint form which referenced Resident #1 documented that Resident #1 alleged via an e-mail to facility staff, including the Director of Nursing, that on 10/23/2010 at approximately 4:50 a.m., a certified nursing assistant (CNA) on the 11:00 p.m. - 7:00 a.m. shift told the resident that if she had to provide care at that time, then she would not get the resident up in the morning. The resident also alleged that the CNA then \"snatched the call light\" and \"snatched the pillows from underneath\" the resident's legs. Review of the facility's investigation revealed that the facility did conduct an investigation into these allegations of neglect and mistreatment, but there was no evidence to indicate that the allegations had been reported to the State survey and certification agency.", "filedate": "2014-04-01"}
{"rowid": 10564, "facility_name": "PRUITTHEALTH - GREENVILLE", "facility_id": 115658, "address": "99 HILLHAVEN RD.", "city": "GREENVILLE", "state": "GA", "zip": 30222, "inspection_date": "2009-08-05", "deficiency_tag": 371, "scope_severity": "F", "complaint": null, "standard": null, "eventid": "DOSV11", "inspection_text": "Based on observations, record review and staff interview the facility failed to prepare food under sanitary conditions for all residents consuming food (facility census 89.) The findings include: Observation of the kitchen on 08/03/09 at 9:00 a.m. revealed the can opener blade contained a thick build-up of a dark, sticky substance. Review of the Daily and Weekly Cleaning Assignments revealed that washing and sanitizing of the can opener blade was not listed. Observation on 08/04/09 at 10:50 a.m. revealed multiple raw chicken pieces in a preparation sink under cold, running water. The water was running over the raw chicken and draining down the sink. Interview with a dietary staff member \"AA\" at this time revealed she did not know that raw meat must also be submerged in water for proper thawing by this method. Interview with the dietary manager on 8/4/09 at 2:35 p.m. revealed she also was not aware this requirement.", "filedate": "2014-04-01"}
{"rowid": 10565, "facility_name": "PRUITTHEALTH - GREENVILLE", "facility_id": 115658, "address": "99 HILLHAVEN RD.", "city": "GREENVILLE", "state": "GA", "zip": 30222, "inspection_date": "2009-08-05", "deficiency_tag": 323, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "DOSV11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review and staff interview the facility failed to ensure that an intervention, clip alarm, to prevent falls was implemented for one (1) resident (#1) from a sample of twenty one (21) residents. The findings include: Observations of resident #1 conducted 08/03/09 at 10:55 a.m. and 12:50 p.m. revealed the resident had no clip alarm on the bed. Further observation on 08/04/09 at 7:55 a.m. revealed there was no alarm on the bed. A second observation on 8/04/09 at 10:30 a.m. revealed the resident was in bed and no clip alarm was on. Interview with Licensed Practical Nurse ( LPN) \"BB\" on 8/4/09 at 11:00 a.m. revealed an clip alarm was located and applied to the resident. Review of the clinical record for resident #1 revealed he was admitted [DATE]. Review of Nurse's Notes revealed he had three (3) falls since admission. These falls occurred on 06/13/09, 07/25/09 and 07/27/09 and were a results of the resident attempting to toilet himself. Following the 07/27/09 fall, the facility added an intervention of a bed clip alarm. Review of the care plan for resident #1 revealed he was care planned for the risk for falls on 05/09/09. On 7/27/09 the care plan was updated to include a clip alarm to bed.", "filedate": "2014-04-01"}
{"rowid": 10566, "facility_name": "PRUITTHEALTH - GREENVILLE", "facility_id": 115658, "address": "99 HILLHAVEN RD.", "city": "GREENVILLE", "state": "GA", "zip": 30222, "inspection_date": "2009-08-05", "deficiency_tag": 365, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "DOSV11", "inspection_text": "Based on observation, record review and staff interview the facility failed to provide the correct consistency diet to meet the needs of one (1) resident (#1) from a sample of twenty one (21) residents. The findings include: Review of the clinical record for resident #1 revealed that on June 24, 2009 the resident's diet was changed to mechanical soft. On June 25, 2009 this diet order was clarified to a Liberalized Diabetic, Mechanical Soft with nectar thick liquids. Observation of the resident's meal on 08/03/09 at 12:50 p.m. revealed the resident received a pureed diet with nectar thick liquids. Observation of the breakfast meal on 08/04/09 at 7:45 a.m. revealed the resident received a pureed diet with nectar thick liquids again. Interview with the Dietary Manager on 08/04/09 at 7:50 a.m. revealed the dietary department did not receive the diet change from the nursing department.", "filedate": "2014-04-01"}
{"rowid": 10567, "facility_name": "PRUITTHEALTH - GREENVILLE", "facility_id": 115658, "address": "99 HILLHAVEN RD.", "city": "GREENVILLE", "state": "GA", "zip": 30222, "inspection_date": "2009-08-05", "deficiency_tag": 520, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "DOSV11", "inspection_text": "Based on staff interviews and review of facility quality assurance records, the facility failed to ensure that the performance improvement plan for missing physician's progress notes was effective for ten (10) residents (#3, #4, #6, #7, #8, #9, #10, #15, #16, and #20) from a sample of twenty-one (21) residents. Findings include: Record reviews for residents #3,#4, #6, #7, #8, #9, #10, #15, #16, and #20 revealed missing physician's progress notes. Interview on 8/4/09 at 3:40 pm with the physician revealed that there has been a problem with progress notes missing from resident's medical records. She further indicated that she has had problems with missing progress notes since October 2008. Interview of 8/5/09 at 9:45 am with the Director of Health Services revealed that the physician's progress notes were missing from resident's medical records. Review of the quality assurance improvement action plan revealed that the facility identified the problem with missing progress notes in February 2009. The plan revealed that physician's progress notes were discussed in the 3/20/09 and 6/29/09 meetings. Each meeting indicated that notes were still missing from medical records. There was no evidence that the approaches developed to resolve the missing progress notes have been effective. According to the plan the last approach was to involve corporate, with a target date of 8/30/09.", "filedate": "2014-04-01"}
{"rowid": 10568, "facility_name": "PRUITTHEALTH - GREENVILLE", "facility_id": 115658, "address": "99 HILLHAVEN RD.", "city": "GREENVILLE", "state": "GA", "zip": 30222, "inspection_date": "2009-08-05", "deficiency_tag": 226, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "DOSV11", "inspection_text": "Based on staff interviews, review of facility policy and records, the facility failed to ensure that two (2) Certified Nurses Assistants (CNA) of five (5) CNAs interviewed had received training on abuse prohibition. Findings include: Review of the facility's Abuse Policy for staff training indicated that training on abuse will be done during initial orientation for all new staff and volunteers. This will include oriented to the facility policy related to abuse prohibition including what constitutes abuse, what to do if they hear or see abuse, and the appropriate interventions to deal with aggressive and/or catatropic reactions of residents/patients,including burnout, stress management and conflict resolution. Interview on 8/4/09 at 3:30 pm with CNA \"ZZ\" revealed that when she was asked about what training she had received related to abuse and neglect, she indicated that she had not received any training at this facility. She further revealed that she had been employed for four (4) months. Interview on 8/4/09 at 3:35 pm with CNA \"XX\" revealed that she has not had any training regarding abuse and that she had not received any facility orientation. She was unaware of who in the facility was responsible for abuse prevention. She further revealed that she had been working for four (4) days. Interview on 8/4/09 at 4:15 pm with the Staff Development Coordinator revealed that she had been at the facility for three (3) weeks and had not conducted any inservices. She further revealed that the facility policy is to teach abuse training during orientation Interview on 8/5/09 at 8:30 am with the Director of Health Services revealed that the last three (3) employees hired and currently working had not had any orientation or abuse training. During review of abuse investigations conducted by the facility and reported to the state agency, revealed two (2) incidents of residents allegations of verbal abuse by CNAs", "filedate": "2014-04-01"}
{"rowid": 10569, "facility_name": "PRUITTHEALTH - GREENVILLE", "facility_id": 115658, "address": "99 HILLHAVEN RD.", "city": "GREENVILLE", "state": "GA", "zip": 30222, "inspection_date": "2009-08-05", "deficiency_tag": 333, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "DOSV11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and review of the Medication Adminisrtation Record (MAR) the facility failed to administer [MEDICATION NAME] according to physician's orders for one (1) resident (#1) on a sample of twenty one (21) residents. The findings include: Review of the clinical record for resident #1 revealed that on 7/23/09 the [MEDICATION NAME] was changed from 100 milligrams (mgs.) two (2) capsules twice a day (b.i.d.)to [MEDICATION NAME] 4mgs (100mgs) suspension per tube every six (6) hours (q6h). The resident has a history of [MEDICAL CONDITION] disorder according to the facility's admission history and physical. Review of the July 2009 Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. The July MAR indicated [REDACTED]. Further review of the July MAR indicated [REDACTED]. Further review of the medical record revealed a physician's order dated 7/26/09 to \"increase [MEDICATION NAME] to 100mgs three times a day (t.i.d.). The July MAR indicated [REDACTED].i.d. with the times of administration as 9am, 3pm, and 9pm. The dates that for administration are 7/23/09 to 7/31/09. There is no evidence that the [MEDICATION NAME] was given on the following dates and times: 7/24 at 9am and 3pm; 7/26 at 9am; and 7/31 at 9am and 3pm. Record review revealed a nurses' note dated 8/3/09 that the physician's and responsible party were notified of the missed [MEDICATION NAME] dosages. The physician ordered a [MEDICATION NAME] level. The results of the [MEDICATION NAME] level was 2.5 ml, which was below the normal range of 10.0 - 20.0. The physician was notified of of this results and ordered the [MEDICATION NAME] be changed to 100mgs every am (Qam), and every pm (Qpm) and 200mgs at bedtime (Qhs).", "filedate": "2014-04-01"}
{"rowid": 10570, "facility_name": "PRUITTHEALTH - GREENVILLE", "facility_id": 115658, "address": "99 HILLHAVEN RD.", "city": "GREENVILLE", "state": "GA", "zip": 30222, "inspection_date": "2009-08-05", "deficiency_tag": 514, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "DOSV11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interviews and record reviews, the facility failed to ensure that physician's progress notes were in the resident's medical record for ten (10) residents (#3, #4, #6, #7, #8, #9, #10, #15, #16, and #20) and that physician's orders [REDACTED]. Findings include: 1. Record reviews for residents #3,#4, #6, #7, #8, #9, #10, #15, #16, and #20 revealed missing physician's progress notes. Interview on 8/4/09 at 3:40 pm with the physician revealed that there has been a problem with progress notes missing from resident's medical records. The physician indicated that she brings her progress notes and facility staff is suppose to place the notes in the residents' records. She further indicated that she has had problems with missing progress notes since October 2008. Interview of 8/5/09 at 9:45 am with the Director of Health Services revealed that the physician's progress notes were missing from resident's medical records. She further revealed that the physician's visits at least once a week but there are no progress notes and that medical records staff are responsible for placing progress notes in the records. 2. Record review for resident # 1 revealed that a [MEDICATION NAME] order written on 7/26/09 by a nurse indicated an \"increase\" in the [MEDICATION NAME] dose to 100mgs. three times a day (t.i.d.). Further record review revealed that on 7/23/09 the [MEDICATION NAME] was ordered 100mgs every six hours (q6h), which is four times a day. The order on 7/26/09 did not reflect an \"increase\" Review of the July 2009 MAR for resident #1 revealed that [MEDICATION NAME] is written as \" [MEDICATION NAME] 4mls (100mgs) per tube q6h t.i.d. with hours of administration as 9am, 3pm, and 9pm. Every six hours (q6h) is not the same as t.i.d. During post survey review of the June 2009 MAR for resident #1 revealed that [MEDICATION NAME] two (2) capsules via tube twice a day (b.i.d) had been marked through and [MEDICATION NAME] 125 mgs/5mls. suspension 4 ml (100mgs) per tube q6h had been written in the same block under the [MEDICATION NAME] capsules. The hours of administration were 9am and 9pm from 6/1- 6/30/09. This does not reflect clear and concise documentation of the dose and frequency of the [MEDICATION NAME].", "filedate": "2014-04-01"}
{"rowid": 10571, "facility_name": "GOLDEN LIVINGCENTER - KENNESTONE", "facility_id": 115660, "address": "613 ROSELANE STREET", "city": "MARIETTA", "state": "GA", "zip": 30064, "inspection_date": "2010-12-13", "deficiency_tag": 203, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "JYL811", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview and record review, it was determined that before transfer/discharge, the facility failed to notify the resident and a family member/legal representative of the transfer/discharge, and of the required information, in writing for one (1) resident (#1) from a survey sample of six (6) residents. Findings include: Record review for Resident #1 revealed a 10/07/2010 physician's orders [REDACTED]. During a telephone interview conducted on 11/01/2010 at 11:30 a.m. with Staff Member \"AA\", this staff member stated that upon review after the resident's hospital transfer, it was determined that the facility could not meet the resident's needs and the decision was made to not readmit the resident. However, further record review revealed no evidence to indicate that the resident and the family member/legal representative were notified, in writing, of the transfer/discharge, the reasons for the transfer/discharge, the effective date of the transfer/discharge, the location to which the resident was transferred/discharged , a statement that the resident had the right to appeal the action to the State, and the name, address and telephone number of the State long term care ombudsman. During an interview with Administrative Staff \"BB\" conducted on 12/13/2010 at 9:45 a.m., this staff member acknowledged that a transfer/discharge notice letter had not been sent.", "filedate": "2014-04-01"}
{"rowid": 10572, "facility_name": "PRUITTHEALTH - AUGUSTA HILLS", "facility_id": 115672, "address": "2122 CUMMING ROAD", "city": "AUGUSTA", "state": "GA", "zip": 30904, "inspection_date": "2010-09-23", "deficiency_tag": 282, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "5C5911", "inspection_text": "Based on record review and staff interview the facility failed to ensure that a care plan related to constipation was followed for one (1) resident (\"C\") on a sample of twenty seven (27) residents. Findings include: Review of the care plan developed for a problem of constipation for resident \"C\" included interventions of assess the resident's bowel elimination pattern, monitor for signs and symptoms of constipation such as no bowel movement in three days and to administer laxatives as ordered. Review of the Activities of Daily Living Care Plan Sheet for July 2010 revealed that between 7/15/10 and 7/22/10 (6 days) there was no documentation that the resident was having bowels movements. Interview with the resident's family on 9/22/10 at 10:45 am revealed that the resident was having symptoms of nausea, spitting up as well as abdominal and rib pain during this time and the facility did nothing until they brought it to their attention. Interview with Director of Nursing (DON) on 9/23/10 at 8:55 am revealed that the care plan was not followed related to the resident's bowel elimination problem. Cross refer to F309", "filedate": "2014-04-01"}
{"rowid": 10573, "facility_name": "PRUITTHEALTH - AUGUSTA HILLS", "facility_id": 115672, "address": "2122 CUMMING ROAD", "city": "AUGUSTA", "state": "GA", "zip": 30904, "inspection_date": "2010-09-23", "deficiency_tag": 309, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "5C5911", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff, and family interview the facility failed to ensure that physician orders [REDACTED]. Findings include: Review of a Nurses Note dated 5/30/10 documented that a resident's (\"C\") family member requested that the resident be given medications for constipation, a problem the resident had had since admission to the facility. Review of the Physician order [REDACTED]. On 5/31/10 there was a Physician order [REDACTED]. Review of the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. Review of the Activities of Daily Living Care Plan sheets for July 2010 revealed there was no documentation that the resident had a bowel movement between 7/16/10 and 7/22/10 (6 days). On 7/22/10 a Physician order [REDACTED]. Review of the August 2010 physician's orders [REDACTED]. The August 2010 MAR documented the [MEDICATION NAME] was given as ordered. The September 2010 Physician order [REDACTED]. A physician's orders [REDACTED].[REDACTED] Interview with the resident's family member on 9/22/10 at 10:45 am revealed that when the facility stopped giving the resident the [MEDICATION NAME] and [MEDICATION NAME] in July 2010 and the resident became impacted, was having abdominal pain and nausea. She stated the staff only addressed this problem after she brought it to their attention. Interview with the DON on 9/22/10 at 11:10 am revealed she received the Physician order [REDACTED]. She confirmed that the [MEDICATION NAME] and the [MEDICATION NAME] were documented as being given in June 2010 even though there was an order to discontinue it on 5/31/10. She also revealed that after the [MEDICATION NAME] and [MEDICATION NAME] was reordered on [DATE] neither medication was carried over on the September 2010 Physician order [REDACTED].", "filedate": "2014-04-01"}
{"rowid": 10574, "facility_name": "PRUITTHEALTH - AUGUSTA HILLS", "facility_id": 115672, "address": "2122 CUMMING ROAD", "city": "AUGUSTA", "state": "GA", "zip": 30904, "inspection_date": "2010-09-23", "deficiency_tag": 279, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "5C5911", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to developed a care plan for one (1) resident (#164) on a sample of twenty seven (27) residents when the resident had a change in condition that required a defibrillator implant. Findings include. Review of the discharge summary dated 6/01/10 for resident #164 revealed the resident was discharged from the hospital to the nursing home with a [DIAGNOSES REDACTED]. Review of Nurses Notes dated 6/23/10 revealed the resident was sent to the hospital for a cardiac defibrillator implant. He returned to the facility on [DATE] with the defibrillator to his left chest with steri-strips intact. There was no evidence in the record that a care plan was developed related to the care and monitoring of the defibrillator implant. Interview with the Licensed Practical Nurse (LPN) Minimal Data Set Assessment Coordinator on 9/22/10 at 8:25 a.m. confirmed there was no care plan for the resident's defibrillator and interventions should have been put into place when the resident returned with the defibrillator implant.", "filedate": "2014-04-01"}
{"rowid": 10575, "facility_name": "PRUITTHEALTH - AUGUSTA HILLS", "facility_id": 115672, "address": "2122 CUMMING ROAD", "city": "AUGUSTA", "state": "GA", "zip": 30904, "inspection_date": "2010-09-23", "deficiency_tag": 372, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "5C5911", "inspection_text": "Based on observation and staff interview the facility failed to ensure that trash and garbage was transported from the main kitchen to dumpsters located outside of the building in a manner to prevent potential contact with residents. Findings include: Observations on 9/21/10 at 10:45 a.m., 9/22/10 at 10:50 a.m., and 9/22/10 at 2:25 p.m. revealed that staff from the facility's kitchen were transporting trash and garbage in open receptacles that were not covered with lids. The observations further revealed that food scraps from resident meals and trash from the kitchen were in these open, unlidded garbage receptacles and that the garbage bags inside the receptacles were not tied to secure their contents. The garbage was transported from the kitchen through the main dining room, through the main facility lobby and then down the 200 hall corridor. The emptied garbage receptacles were returned from the trip to the dumpsters back to the kitchen via the same reverse route. This information was confirmed in an interview with the facility's Food Service Director (FSD) on 9/23/10 at 11:30 a.m.", "filedate": "2014-04-01"}
{"rowid": 10576, "facility_name": "PRUITTHEALTH - AUGUSTA HILLS", "facility_id": 115672, "address": "2122 CUMMING ROAD", "city": "AUGUSTA", "state": "GA", "zip": 30904, "inspection_date": "2010-09-23", "deficiency_tag": 248, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "5C5911", "inspection_text": "Based on observation, record review and staff interview the facility failed to provide an activity program that met the needs of one (1) resident, #58, from a sample of twenty-seven (27) residents. Findings include: Record review of resident #58 revealed that she had experienced a recent mental and physical decline and spent her days in her room because she did not feel like attending group activities. The resident also ate all of her meals in her room. Observations of the resident during the course of a standard survey conducted on September 20-23, 2010 confirmed that the resident remained in her room during this period of time. There were no observed visits by the Activity Department staff to the resident during this time frame. There was also no Activity Calendar posted in the resident's room. A review of the resident's Care Plan dated 7/05/10 and updated on 9/15/10 revealed that the resident was at risk for social isolation and her Care Plan had interventions which included the provision of 1:1 in room visits by the activity staff as well as the provision of activity supplies for the resident. The interventions also provided for an Activity Calendar to be posted in the resident's room. An interview with the facility's Activity Director (AD) on 9/22/10 at 3:00 p.m. revealed that the resident was placed on an activity plan in July 2010 that provided her with 1:1 visits at least twice per week. These personal visits were to include reading, massages, nail care, aroma therapy and social visits. However, the AD confirmed in the interview that the resident had not been provided with an individualized program and that she had not been provided with any in-room activities as planned.", "filedate": "2014-04-01"}
{"rowid": 10577, "facility_name": "PRUITTHEALTH - AUGUSTA HILLS", "facility_id": 115672, "address": "2122 CUMMING ROAD", "city": "AUGUSTA", "state": "GA", "zip": 30904, "inspection_date": "2010-09-23", "deficiency_tag": 463, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "5C5911", "inspection_text": "Based on observation and staff interview the facility failed to ensure that all call lights located in resident rooms were functioning properly. Eight (8) of forty-five (45) call lights tested were found to be defective. Findings include: During the course of the standard survey investigative process, 45 call lights were tested to see if they were functional. The following resident rooms contained call lights that were not working: 107A; 201 bathroom; 313A; 313B; 313C; 315A; 315B; and 315C. This information was confirmed by Licensed Practical Nurse \"JJ\" at the time of observation on 9/21/10 at 1:50 p.m.", "filedate": "2014-04-01"}
{"rowid": 10578, "facility_name": "NEW LONDON HEALTH CENTER", "facility_id": 115771, "address": "2020 MCGEE ROAD", "city": "SNELLVILLE", "state": "GA", "zip": 30078, "inspection_date": "2009-09-24", "deficiency_tag": 161, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "W1TL11", "inspection_text": "Based on record review and staff interview, the facility failed to maintain a surety bond of equal or greater value, than the balance in the residents' trust fund accounts. The facility managed seventeen (17) resident accounts. Findings include: Record review with the Nursing Home Administrator and Business Office Manager on 9/24/09 revealed that the residents' trust fund account balance was $11,478.00. Further review revealed bank statements with average ending balances ranging between 12,300.04 to 10,308.17 for the months of May, June, July, and August 2009. The facility's surety bond was in the amount of $10,000.00. In an interview with the Nursing Home Administrator on 9/24/09 at 8:30 a.m., he acknowledged that the surety bond amount was insufficient.", "filedate": "2014-04-01"}
{"rowid": 10579, "facility_name": "NEW LONDON HEALTH CENTER", "facility_id": 115771, "address": "2020 MCGEE ROAD", "city": "SNELLVILLE", "state": "GA", "zip": 30078, "inspection_date": "2009-09-24", "deficiency_tag": 363, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "W1TL11", "inspection_text": "Based on observation, record review and staff interview the facility failed to follow menus for two (2) meals during the survey. This had the potential to affect most residents consuming food (total = 132). Findings include: Review of the menus provided by the facility revealed pancakes or waffles were to be served for breakfast 9/23/09. Observation of the breakfast meal revealed neither were served to residents, they received toast instead. During an interview with the Dietary Manager (DM) on 9/23/09 at 10:20 a.m. she stated the facility did not serve pancakes or waffles because one (1) or two (2) years ago residents complained the items were served cold and/or hard. Review of the four (4) week cycle menu provided by the facility revealed a variety of starch-based food items were listed contributing to the menu variety. These items included muffins, biscuits, french toast, pancakes, Danish, waffles and cinnamon rolls. Interview with the DM at 2:20 p.m. revealed the facility did not serve any of these products but always served toast instead. The menu also called for lettuce and tomato to be served as part of the dinner meal on 9/23/09. Interview with the DM on 9/23/09 at 8:30 a.m. and 10:30 a.m. revealed they were not serving lettuce but only diced tomatoes. She stated residents can choke on lettuce and that it was also a food waste issue. Review of the grievance file and resident council minutes since 10/2008 revealed no notation about pancakes, waffles or lettuce.", "filedate": "2014-04-01"}
{"rowid": 10580, "facility_name": "NEW LONDON HEALTH CENTER", "facility_id": 115771, "address": "2020 MCGEE ROAD", "city": "SNELLVILLE", "state": "GA", "zip": 30078, "inspection_date": "2009-09-24", "deficiency_tag": 371, "scope_severity": "F", "complaint": null, "standard": null, "eventid": "W1TL11", "inspection_text": "Based on observation, record review and staff interview the facility failed to store, prepare and serve food under sanitary conditions for all residents consuming food (total = 132). Findings include: Observation during initial tour of the kitchen on 9/22/09 at 9:35 a.m. revealed the wall around the stainless steel counter near the dishmachine was soiled with a black substance in the grout and on the wall and continued under the counter. This wall area also had a build up of substances that were dried and sticky. Three (3) used dishcloths were observed on the bottom shelf of a cart next to clean serving trays. Observation of the right reach-in cooler revealed two (2) fat-free milks with a use-by date of 9/20/09. The walk-in cooler had two (2) containers of buttermilk with use-by dates of 9/04/09 and 9/16/09. Also in this walk-in cooler were prepared ground sausage, pureed sausage and pureed eggs dated 9/23/09. Interview with the Dietary Manager (DM) at this time revealed these items were prepared 9/22/09 to be served for breakfast on 9/23/09. She stated these items were prepared ahead of time instead of on the day of service because staff often came in late in the mornings. Observation on 9/23/09 at 7:25 a.m. revealed dietary staff \"AA\" operating the three (3) compartment sink. She was washing and sanitizing items in full sinks of water. However, she was rinsing items under running water without submerging in a full sink of rinse water as required. Interview with the DM at this time revealed she agreed the correct procedure was not being followed. Observation at 9:50 a.m. revealed a bucket with several dishcloths immersed in water. The DM stated the facility used chlorine in the bucket as a sanitizer but she twice attempted to test the sanitizer level with the wrong chemical strips. When she used the correct chlorine test strip, chlorine did not register as present in the solution. Observation at 10:00 a.m. revealed packaged turkey in a pan of water on a preparation counter. The DM stated it was being thawed. Observation of lunch trayline at noon revealed the DM had calibrated the thermometer but stated she did not have alcohol pads in the kitchen to sanitize the thermometer. She stated she knew the nurse's carts contained the sanitizer swabs but preceded to take food temperatures without sanitizing the thermometer first. Several foods were in the warming oven. When these foods were tested the chicken was 112 degrees Fahrenheit (F), soup 116 degrees, gravy 110, ham 135, and pureed meat 122 degrees. The DM stated the warmer was set on the highest temperature. At 12:15 p.m. a garbage can lid was observed sitting with the inner surface on a table. The edge of the garbage can lid was hanging directly over clean dish racks. The DM was present during all these observations.", "filedate": "2014-04-01"}
{"rowid": 10581, "facility_name": "NEW LONDON HEALTH CENTER", "facility_id": 115771, "address": "2020 MCGEE ROAD", "city": "SNELLVILLE", "state": "GA", "zip": 30078, "inspection_date": "2009-09-24", "deficiency_tag": 221, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "W1TL11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview the facility failed to apply a restraint as ordered for one (1) resident (#12) on a sample of twenty four (24) residents. Findings include: Review of the clinical record for resident #12 revealed a physician's orders [REDACTED]. Observation of this resident on 9/22/09 at 11:50 a.m. and 12:35 p.m. and 9/23/09 at 7:30 a.m. and 11:15 a.m. revealed the resident was in his wheelchair with a full lap table and wearing the left hand mitten. Interview with the Director of Nursing (DON) on 9/23/09 at 11:00 a.m. revealed the resident has the mitten because he continually touches his gastrostomy tube and pulled it out 7/16/09. She also stated he does wear an abdominal binder at all times in the wheelchair. There was no indication why the resident was also wearing the left hand mitten while in his wheelchair, since this device was ordered for use in the bed. The DON added at that time, that with the abdominal binder and a full lap tray the resident would have difficulty accessing the gastrostomy tube while in the wheelchair. She confirmed that the mitten should not be applied.", "filedate": "2014-04-01"}
{"rowid": 10582, "facility_name": "NEW LONDON HEALTH CENTER", "facility_id": 115771, "address": "2020 MCGEE ROAD", "city": "SNELLVILLE", "state": "GA", "zip": 30078, "inspection_date": "2009-09-24", "deficiency_tag": 314, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "W1TL11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interviews, it was determined that for three (3) of the twenty-four (24) sampled residents, #1, #6 and #19, the facility failed to prevent pressure ulcers from forming for residents not previously having pressure ulcers and failed to treat pressure ulcers appropriately to promote healing and prevent new ulcers from forming. Findings include: Review of the clinical record for resident #1 revealed a Minimum Data Set ((MDS) dated [DATE] that indicated the resident had intact skin, with no breakdown. Section M5 of this document also indicated that staff was not using any protective or preventive skin care. However, review of the Master Care Plan revealed that the resident was assessed as being at risk for pressure ulcers. A progress note by the Nurse Practitioner and attending physician, dated 09/17/09 described a Stage II ulcer behind her left ear. Observation of this pressure ulcer on 09/22/09 at 2:15 a.m. revealed that the resident was wearing eye glasses and had plastic tubing around her ears for receiving supplemental oxygen. There was also a dressing in place behind her left ear. Interview with the Director of Nurses on 09/23/09 at 7:45 a.m. indicated that she was unaware of any preventive measures that had been put into place to prevent this pressure ulcer from forming. Record review for resident #6 revealed the resident a care plan dated 12/31/08 that indicated the resident had a potential for skin breakdown. A Nurse's Note dated 9/11/09 indicated the resident had received a skin shear to the right buttock. This was described as a Stage II pressure area measuring 0.2 centimeter in diameter. The Treatment Record for September 2009 described this Stage II wound on the right buttock as a skin shear. During an observation of the resident receiving incontinent care on 9/22/09 at 2:30 p.m., the Stage II pressure sore on the right buttock was not covered by a dressing, but the skin was intact. The resident's left buttock was observed with one (1) reddened open area and one (1) closed reddened area. In an interview with Certified Nursing Assistant (CNA) \"NN\" at the time of this observation, she stated that she did not know about the dressing on the right buttock and she thought the open area on the left buttock was there when she changed the resident earlier. CNA \"MM\" stated that she was not aware of the open areas on the left buttock, nor any skin impairment on the right buttock. During a second observation of the resident on 9/23/09 at 9:50 a.m. with Treatment Nurses \"RR\" and \"ZZ\", both nurses stated that they had not been made aware of the two new areas on the left buttock. One area was red and open during this observation. LPN \"ZZ\" described the open area as a skin shear which would be a Stage II wound. They both indicated that the CNA's should have notified them or the Unit Manager of any changes in the resident's skin. In an interview with the Unit Manager on 9/23/09 at 10:10 a.m., she stated that CNA's \"NN\" and \"MM\" had not notified her of any new areas of skin breakdown or that the pressure sore dressing was not in place on the right buttock. Review of the facility's policy on the Prevention of Pressure Ulcers revealed that staff were directed to avoid friction and skin shears by using appropriate lift techniques rather than dragging when repositioning. Record review revealed that resident #19 had Stage II pressure sores on the right hip and left ischium. Review of current physician's orders [REDACTED]. During an observation of incontinent care for resident #19, on 9/23/09 at 3:10 p.m. with Certified Nursing Assistants (CNA) \"DD\" and \"EE\", there were no dressings on the pressure sores. Observation of the resident's pressure sores later that day at 3:25 p.m. with Licensed Practical Nurse (LPN) \"ZZ\" revealed that these wounds still did not have a dressing. She further indicated that she had not been advised that the dressings were not in place. An interview with LPN \"ZZ\" on 9/24/09 at 4:00 p.m. revealed she had no explanation as to why the dressings were not in place on the previous day or why the CNA's had not notified her.", "filedate": "2014-04-01"}
{"rowid": 10583, "facility_name": "NEW LONDON HEALTH CENTER", "facility_id": 115771, "address": "2020 MCGEE ROAD", "city": "SNELLVILLE", "state": "GA", "zip": 30078, "inspection_date": "2009-09-24", "deficiency_tag": 323, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "W1TL11", "inspection_text": "Based on observation and staff interview, the facility failed to maintain an environment that remained free of accidents hazards as is possible. This was evidenced by the failure to ensure safe storage of drugs and therapeutic agents, to prevent access by cognitively impaired residents for one of five (1 of 5) medication carts. Findings include: Observation on 9/22/09 at 3:35 p.m. revealed that the medication cart on the A Hall was unlocked. All drawers (except the narcotic box) were able to be opened. No staff was in attendance, or in the vicinity. The Nurse's Station was approximately 50-60 feet away. Licensed Practical Nurse (LPN) \"GG\" was observed approaching the cart from the Nurse's Station. In an interview with LPN \"GG\" on 9/22/09 at 3:40 p.m. she acknowledged that the medication cart should be locked when leaving it unattended.", "filedate": "2014-04-01"}
{"rowid": 10584, "facility_name": "TOWER ROAD HEALTHCARE AND REHABILITATION CENTER", "facility_id": 115115, "address": "26 TOWER RD", "city": "MARIETTA", "state": "GA", "zip": 30060, "inspection_date": "2010-11-14", "deficiency_tag": 309, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "K6XU11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interviews, it was determined that the facility failed to administer a medication, [MEDICATION NAME] (blood thinner) as ordered for one (1) resident #1 in a survey sample of six (6) residents. Findings include: A review of the 10/27/2010 physician's orders [REDACTED]. Review of the Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. During an interview with the Director of Nursing on 11/14/2010 at 1:00 p.m., it was confirmed that the medication was not administered on 10/27/2010. In addition, an interview and observation with the Director of Nursing at 2:00 p.m. revealed that the [MEDICATION NAME] was at the facility on 10/27/2010 and available to be administered.", "filedate": "2014-03-01"}
{"rowid": 10585, "facility_name": "MAGNOLIA MANOR OF COLUMBUS NURSING CENTER - EAST", "facility_id": 115124, "address": "2010 WARM SPRINGS RD", "city": "COLUMBUS", "state": "GA", "zip": 31904, "inspection_date": "2010-11-10", "deficiency_tag": 281, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "Inf", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, clinical record review, staff interview, review of a facility nurse's written statement, and review of the Model Nurse Practice Act/Model Nursing Administrative Rules, the facility failed to ensure that services, regarding medication administration, were provided in accordance with professional standards of quality and a physician's orders [REDACTED]. Findings include: As specified in the Model Nurse Practice Act/Model Nursing Administrative Rules, Chapter Two - Standards of Nursing Practice, Part 2.3.2 (J), Standards Related to Licensed Practical/Vocational Nurse, the nurse will administer medications accurately. Record review for Resident #1 revealed a current November 2010 physician's orders [REDACTED]. However, observation of Resident #1 conducted on 11/09/2010 at 4:30 p.m. revealed two [MEDICATION NAME]es applied to the resident's back. One [MEDICATION NAME] was dated as having been applied on 11/08/2010 and was on the resident's right back shoulder area. The second patch had an illegible date of application and was on the resident's right mid-back. This was acknowledged by Nurse \"AA\" and the Director of Nursing (DON), both of whom were in attendance at the time of this observation. During an interview with the DON conducted on 11/09/2010 at 4:40 p.m., the DON acknowledged that only one [MEDICATION NAME] should have been applied to Resident #1. In a written statement dated 11/11/2010 provided by Nurse \"BB\", Nurse \"BB\" documented that on 11/08/2010, she had removed a [MEDICATION NAME] dated 11/05/2010 from the left chest of Resident #1, and had then applied a new [MEDICATION NAME]. The nurse further documented that during the application of the [MEDICATION NAME] on 11/08/2010, the resident had exhibited some agitation, and that during the process of providing the resident comfort, she did not recall taking the removed [MEDICATION NAME] off the bed and discarding it. The nurse then indicated in her statement that this could have resulted in the removed patch becoming reattached to the resident when the certified nursing assistant turned the resident in the bed. Based on the above, the facility failed to provide drug therapy in accordance with professional standards, as ordered by the physician, by failing to ensure the proper removal and disposal of the [MEDICATION NAME] for Resident #1.", "filedate": "2014-03-01"}
{"rowid": 10586, "facility_name": "OXLEY PARK HEALTH AND REHABILITATION", "facility_id": 115387, "address": "181 OXLEY DRIVE", "city": "LYONS", "state": "GA", "zip": 30436, "inspection_date": "2009-10-22", "deficiency_tag": 323, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "B8MH11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and record review, it was determined that the facility failed to ensure that one resident (#11) of 13 residents dependent on staff for transfers was appropriately transferred from the wheelchair to the bed from a total sample of 18 residents. Findings include: Resident #11 had a [DIAGNOSES REDACTED]. His/her care plan did not include any interventions to address his/her need for staff assistance to transfer. On 10/20/09 at 1:25 p.m., during an observation of the resident being transferred from his/her wheelchair to the bed, two certified nursing assistants (CNAs) inappropriately lifted the resident under his/her arms and by the waistband of the resident's pants.", "filedate": "2014-03-01"}
{"rowid": 10587, "facility_name": "CORDELE HEALTH AND REHABILITATION", "facility_id": 115429, "address": "1106 NORTH 4TH STREET", "city": "CORDELE", "state": "GA", "zip": 31015, "inspection_date": "2010-09-01", "deficiency_tag": 241, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "W2R511", "inspection_text": "Based on observation, it was determined that the facility failed to provide care in a dignified manner for one resident (#9) from a total sample of 16 residents. Findings include: On the 6/9/10 significant change of status Minimum Data Set (MDS) assessment, licensed nursing staff coded resident #9 as being dependent on staff for bed mobility, dressing, personal hygiene and toileting. During the provision of incontinence care by CNA \"MM\" on 8/30/10 at 2:40 p.m., the resident's draw sheet and fitted sheet were observed to be wet with urine. After applying a clean brief, certified nursing assistant (CNA) \"MM\" did not remove or change those wet sheets. At that time, CNA \"MM\" stated that the hospice CNA was in the building and would be returning to give the resident a bed bath. However, it was observed that the resident laid on the wet sheets until at least one hour later, at 3:40 p.m., when the hospice CNA was bathing the resident and then changed the wet sheets.", "filedate": "2014-03-01"}
{"rowid": 10588, "facility_name": "CORDELE HEALTH AND REHABILITATION", "facility_id": 115429, "address": "1106 NORTH 4TH STREET", "city": "CORDELE", "state": "GA", "zip": 31015, "inspection_date": "2010-09-01", "deficiency_tag": 309, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "W2R511", "inspection_text": "**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 administer medication as ordered for one resident (#6) and failed to obtain a physician's orders [REDACTED].#8), from a total sample of 16 residents. Findings include: 1. Resident #8 had a physician's orders [REDACTED]. A review of the resident's June 2010 Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. However, review of the clinical record revealed that there was no evidence of a physician's orders [REDACTED]. During an interview on 8/31/10 at 3:30 p.m., licensed nurse \"AA\" confirmed that there was not a physician's orders [REDACTED]. Licensed nurse \"AA\" stated on 8/31/10, after surveyor inquiry, that she had clarified the order with the physician, who wanted it to be administered routinely. 2. Resident #6 had been receiving 3.5 milligrams (mg) of [MEDICATION NAME] daily since 7/23/10. On 7/29/10, the physician ordered 100 milligrams (mg) of [MEDICATION NAME] (an antibiotic) twice daily for ten days to treat a urinary tract infection. There was an 8/2/10 physician's orders [REDACTED]. PT and INR levels were obtained on 8/5/10. The results were available on 8/6/10. The resident's PT and INR levels were reported as having been abnormally high at 25.1 ( normal range 9.5 to 11.8 seconds) and 4.29 respectively. There was a handwritten physician's orders [REDACTED]. However, a review of the August 2010 MAR indicated [REDACTED]. Another PT and INR level was obtained on 8/8/10 with the results available on 8/8/10. The PT and INR levels had increased and were reported as having been critically high at 31.4 and 5.42 respectively. At that time, [MEDICATION NAME] was ordered to be held and then the other orders for reducing the dosage of [MEDICATION NAME] and obtaining PT/INR levels were followed.", "filedate": "2014-03-01"}
{"rowid": 10589, "facility_name": "CORDELE HEALTH AND REHABILITATION", "facility_id": 115429, "address": "1106 NORTH 4TH STREET", "city": "CORDELE", "state": "GA", "zip": 31015, "inspection_date": "2010-09-01", "deficiency_tag": 312, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "W2R511", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, it was determined that the facility failed to ensure that oral hygiene was performed as needed for one resident (#9), from a total sample of 16 residents. Findings include: Resident #9 had medical [DIAGNOSES REDACTED]. On the 6/9/10 significant change of status Minimum Data Set (MDS) assessment, licensed nursing staff coded resident #9 as having been dependent on staff for hygiene and bathing. Resident #9 only received nutrition (enteral formula) through a gastrostomy tube. It was observed on 8/30/10 at 11:15 a.m., 1:15 p.m., and 2:15 p.m. that nursing staff had not provided oral care and the resident had a heavy build-up of a thick, white substance on his/her lips.", "filedate": "2014-03-01"}
{"rowid": 10590, "facility_name": "CORDELE HEALTH AND REHABILITATION", "facility_id": 115429, "address": "1106 NORTH 4TH STREET", "city": "CORDELE", "state": "GA", "zip": 31015, "inspection_date": "2010-09-01", "deficiency_tag": 164, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "W2R511", "inspection_text": "Based on observations and resident interviews, it was determined that the facility failed to provide privacy while bathing and assistance with dressing for two residents (\"A\" and \"B\") of five residents interviewed. Findings include: During the group interview on 8/30/10 at 1:50 p.m., two of the four residents in attendance complained that they did not like the nursing staff allowing other residents to be in the shower room while they were receiving care. On 8/31/10 at 10:20 a.m. and at 3:40 p.m., it was observed that the common shower room had a key pad lock on the outside of the door but, the door was not completely closed. Upon entering the shower room, there was a central area with a commode and sink, which was surrounded by three (3) shower stalls and one tub stall. Each of those stalls had privacy curtains to provide personal privacy for a resident while being bathed. During an interview on 8/31/10 at 10:20 a.m., Certified Nursing Assistant (CNA) \" RR\" stated each CNA baths assigned residents. \"RR\" said that the shower room door should be locked so, other residents could not come. He/she stated that residents were dressed in the central area of the shower room after they received a shower. It was observed at that time that there was not a means to ensure personal privacy in the central area where residents were dressed. During an interview on 9/1/10 at 11:00 a.m., the Administrator stated that the shower room door did not automatically lock when closed. She said that there was a \"lock\" button on the outside that had to be pushed before the door was locked. She said that several residents preferred to use the commodes in the common shower room rather than the bathrooms in their own rooms. Resident \"A\" stated on 8/30/10 at 1:50 p.m. that during his/her shower in the common shower room, the privacy curtain was pulled around the shower stall but the shower room door was not locked and several residents came into the room to use the toilet. The resident said that he/she felt uncomfortable with other residents coming in and out of the room while he/she was undressed. The resident stated that after his/her shower, the nursing staff took him/her into the central area of the shower room to assist him/her with dressing while other residents were in the area. Resident \"B\" stated on 8/30/10 at 1:50 p.m., that there were usually two to three residents in the shower stalls in the common shower room receiving a shower at the same time. The resident stated that the door was not always locked so, other residents entered in the shower room during his/her shower which he/she did not like it. The resident stated that staff took him/her to the center of the shower room to get dressed after his/her shower while other residents were present.", "filedate": "2014-03-01"}
{"rowid": 10591, "facility_name": "CORDELE HEALTH AND REHABILITATION", "facility_id": 115429, "address": "1106 NORTH 4TH STREET", "city": "CORDELE", "state": "GA", "zip": 31015, "inspection_date": "2010-09-01", "deficiency_tag": 328, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "W2R511", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview and record review, it was determined that the facility failed to ensure that oxygen tubing and nasal cannulas were appropriately stored when not in use for three residents (#12 and two randomly observed residents), that nebulizer masks and tubing were appropriately stored when not in use for four residents (#9 and three randomly observed residents), that the humidifier bottle was filled with water for one resident (#9), and that an oxygen cannister was appropriately secured for one randomly observed resident from four sampled residents and 13 total resident receiving respiratory treatment. Findings include: According to the facility's Resident Census and Conditions of Resident from (dated 8/30/10), 13 residents were receiving respiratory treatment. 1. During an observation of resident #9 on 8/30/10 at 11:15 a.m., his/her nebulizer mask and tubing had been inappropriately stored uncovered on top of the nebulizer compressor. Resident #9 received oxygen continuously at 2 liters per minute through a nasal cannula. It was observed on 8/30/10 at 11:15 a.m., 1:15 p.m. and 2:40 p.m., and on 8/31/10 at 9:00 a.m., 12:35 p.m., 1:30 p.m., and 3:15 p.m. that the humidifier bottle on the oxygen concentrator was empty. During an interview on 9/1/10 at 11:20 a.m., the Director of Nursing (DON) stated that the nurses were responsible for ensuring that there was water in the humidifier bottles on the oxygen concentrators. On 9/1/10 at 11:40 a.m., licensed nurse \"BB\" stated that water was not added to the humidifier bottles but, the bottles were changed out weekly. However, the facility's policy on Use of Oxygen instructed nursing staff that if a reusable humidifier was used, it should be emptied, rinsed, dried and refilled with sterile water daily. 2. The front panel of resident #12's oxygen concentrator was dusty . The oxygen tubing and nasal cannula were uncovered and draped over the night stand on 8/31/10 at 3:40 p.m. and on 9/1/10 at 9:40 a.m. 3. During the initial tour on 8/30/10 at 9:15 a.m., there were two uncovered nebulizer masks draped over the nebulizer machines by beds 105 A and 105 B. Resident #15 in room [ROOM NUMBER] used a nebulizer. 4. During the initial tour on 8/30/10 at 9:30 a.m., the oxygen tubing for the resident in room [ROOM NUMBER] A was uncovered and on the floor. 5. During the intial tour on 8/30/10 between 9:00 a.m. and 10:00 a.m., there was an uncovered nebulizer mask draped over the nebulizer machine in room [ROOM NUMBER]B. 6. During the intial tour on 8/30/10 between 9:00 a.m. and 10:00 a.m. there was an uncovered nebulizer mask draped over a nebulizer machine, an uncovered oxygen nasal cannula wrapped around an unsecured small cylinder of oxygen at the bedside of room [ROOM NUMBER]B. It was observed on 9/1/10 at 11:00 a.m. that the oxygen cylinder remained unsecured and the mask and cannula remained uncovered.", "filedate": "2014-03-01"}
{"rowid": 10592, "facility_name": "CORDELE HEALTH AND REHABILITATION", "facility_id": 115429, "address": "1106 NORTH 4TH STREET", "city": "CORDELE", "state": "GA", "zip": 31015, "inspection_date": "2010-09-01", "deficiency_tag": 323, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "W2R511", "inspection_text": "Based on observation and record review, it was determined that the facility failed to safely store hazardous chemicals to prevent residents' access in two of two common shower rooms(women's and men's). Findings include: During the General Observations Tour of the facility on 9/1/10 from 10:45 a.m. to 11:25 a.m., the following observations were made: 1. The Women's Shower was unlocked and unsupervised. Staff had not locked a cabinet in that shower which contained a spray bottle of Germicidal Cleaner. The bottle had the printed manufacturer's recommendation \"to keep out of reach of children, may cause eye or skin irritation.\" There was also a container of Cavi Wipes with a cautionary label that it was harmful if absorbed through the skin and caused moderate eye irritation. 2. The Men's Shower room was unlocked and unsupervised. Staff had left a spray bottle of Germicidal Cleaner hanging on the handrail in one of the shower stalls with a manufacturer's recommendation to keep out of reach of children and may cause eye or skin irritation.", "filedate": "2014-03-01"}
{"rowid": 10593, "facility_name": "CORDELE HEALTH AND REHABILITATION", "facility_id": 115429, "address": "1106 NORTH 4TH STREET", "city": "CORDELE", "state": "GA", "zip": 31015, "inspection_date": "2010-09-01", "deficiency_tag": 225, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "W2R511", "inspection_text": "Based on record review, it was determined that the facility failed to thoroughly investigate the past histories of two of ten newly hired employees. Findings include: A review of ten (10) newly hired employees' files revealed that two did not contain evidence of the results of a criminal background check. 1. A certified nursing assistant began working at the nursing facility on 8/16/10 after transferring from another one. However, the facility failed to obtain a new criminal background check. The previous criminal background check results had been obtained on 10/4/05. 2. A certified nursing assistant was hired on 6/10/10. The facility originally requested a background check on 6/2/10. However, there was no evidence that the results were obtained until another request was made on 8/31/10.", "filedate": "2014-03-01"}
{"rowid": 10594, "facility_name": "CORDELE HEALTH AND REHABILITATION", "facility_id": 115429, "address": "1106 NORTH 4TH STREET", "city": "CORDELE", "state": "GA", "zip": 31015, "inspection_date": "2010-09-01", "deficiency_tag": 371, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "W2R511", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview and record review, it was determined that the facility failed to dispose of 11 bottles of expired [MEDICATION NAME] enteral nutrition. Findings include: On 9/1/10 at 11:15 a.m., 11 bottles of [MEDICATION NAME] enteral nutrition were observed being stored in a cabinet in the floor pantry. They had an expiration date of 7/1/2010. During an interview on 9/1/10 at 11:45 a.m., the Director of Nursing stated that were not any residents receiving [MEDICATION NAME] at that time. She stated that she was not sure who was responsible for checking the expiration dates on supplements and enteral feedings.", "filedate": "2014-03-01"}
{"rowid": 10595, "facility_name": "CORDELE HEALTH AND REHABILITATION", "facility_id": 115429, "address": "1106 NORTH 4TH STREET", "city": "CORDELE", "state": "GA", "zip": 31015, "inspection_date": "2010-09-01", "deficiency_tag": 469, "scope_severity": "F", "complaint": null, "standard": null, "eventid": "W2R511", "inspection_text": "Based on observations and interviews with residents and staff, it was determined that the facility failed to maintain an effective pest control program so that the facility was free of flies in the dining rooms, and the 200 hallway. Findings include: 1. During the group interview held after lunch on 8/30/10 at 1:50 p.m., all four residents in attendance complained about flies in the dining room, residents' rooms and hallways of the facility. Resident \"A\" had a fly swatter with him/her at the meeting and several flies landed on his/her shirt during the meeting. Resident \"U\" stated that the flies were awful this year and pointed out two lights in the dining room that he/she stated were purchased by the facility to help get rid of the flies. One of those lights was turned on at that time but, the other one was unplugged. Several flies were seen in the room during the meeting. 2. On 8/30/10 at 12:50 p.m., several flies were observed in the large dining room while the residents were being served lunch. One fly was on a resident's head. One was crawling on the floor. Staff members, who were assisting residents with their meals, were swatting the flies away with their hands. 3. During an interview on 8/31/10 at 5:30 p.m., the Administrator stated that the bug lights were purchased to help get rid of flies. She said that she had been advised by the Pest control company that the lights were supposed to stay off until meal time so they would attract the flies during the meal times. However, it had been observed on 8/30/10 at 1:50 p.m. that one of the bug lights was on after the mid-day meal in the large dining room. However, on 8/31/10 at 8:25 a.m. and 12:20 p.m. during the meals, the bug light in the small dining room on the 200 hall had not been turned on by staff but, the two in the main dining room had been. At 12:40 p.m., two flies were observed in the large dining room. There were flies in the 200 hallway and outside of room 214. 5. During an interview on 9/1/10 at 10:45 a.m. resident \"F\" stated that he/she ate all meals in the small dining room. The resident stated that since the weather had been hot, he/she had seen flies in the small dining room every day during meals. The resident stated that he/she carried a fly swatter. 5. In an interview on 9/1/10 at 10:30 a.m., resident \"G\" stated that he/she saw flies in the small dining room every day while eating his/her meals. 6. There was a fly in the room during observation of wound care being provided for resident #3 on 8/31/10 at 10:10 a.m. The licensed nurse, who was providing wound care, swatted at the fly with his/her hand to keep it away from the resident. 7. During an interview on 9/1/10 at 9:00 a.m., resident \"C\" stated that the flies had been so bad he/she thought that all of the residents should be given their own personal fly swatters. He/she stated that his/her family had brought him/her one. 8. On 9/1/10 at 9:30 a.m., the administrator said that last week the pest control company had identified a potential problem with the doors at the end of North Hall. It was observed on 8/31/10 at 12:40 p.m. that the double doors at the end of North Hall had not been maintained to prevent the ingress of insects and flies.", "filedate": "2014-03-01"}
{"rowid": 10596, "facility_name": "CORDELE HEALTH AND REHABILITATION", "facility_id": 115429, "address": "1106 NORTH 4TH STREET", "city": "CORDELE", "state": "GA", "zip": 31015, "inspection_date": "2010-09-01", "deficiency_tag": 253, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "W2R511", "inspection_text": "Based on observations, it was determined that the facility failed to repair chipped and/or broken shower tiles in two of two shower rooms, failed to repair a leaking sink in the floor pantry, failed to clean dust from an oscillating fan in one room, failed to maintain a clean microwave on station II, and failed to replace a light switch cover in one room, failed to maintain intact double doors on one hall from a review of both wings. Findings include: The following observations were made during the Initial Tour of the facility on 8/30/10 from 8:45 a.m. to 10:30 a.m. and during the General Observations Tour on 9/1/10 from 10:45 a.m. to 11:25 a.m.: 1. There was a dusty oscillating fan in room 105. 2. The light switch cover was missing in the bathroom of room 106. 3. Tere was a small trash can containing dirty gloves outside of the doors at the end of 200 hall. There was mold growing inside it. 4. There was dried food debris on the inside of a microwave on Station II. 5. Three shower stalls in the women's bath had chipped and/or broken tiles with dull edges. 6. One shower stall in the men's bath had chipped and/or broken tile. 7. The floor was stained around the base of the commode in the men's common bath. 8. The plumbing under the sink in the floor pantry was leaking. 9. It was observed on 8/31/10 at 12:40 p.m. that double doors at the end of North Hall had not been maintained. The bottom of of the North Hall egress double door was not flush with the floor which left an opening to the exterior of the building. Although the double doors met in the center of the door frame, a section at the center of each door had been gouged which resulted in a hole when the doors were closed. The hole provided an opening to the exterior of the building. See F469 example #8 for additional information about the doors at the end of North Hall.", "filedate": "2014-03-01"}
{"rowid": 10597, "facility_name": "CORDELE HEALTH AND REHABILITATION", "facility_id": 115429, "address": "1106 NORTH 4TH STREET", "city": "CORDELE", "state": "GA", "zip": 31015, "inspection_date": "2010-09-01", "deficiency_tag": 514, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "W2R511", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, it was determined that the facility failed to ensure that licensed nurses documented administration of two medications on the August Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. Findings include: Resident #9's physician had ordered 400 milligrams (mg) of [MEDICATION NAME] be administered twice daily through the gastrostomy tube. [MEDICATION NAME] was scheduled to be administered at 5:00 a.m. and 5:00 p.m. However, licensed nursing staff failed to document that the 5:00 p.m. dose of [MEDICATION NAME] had been administered on 8/27/10, 8/28/10, 8/29/10, 8/30/10 and 8/31/10. There was a 8/25/10 physician's orders [REDACTED]. However, licensed nursing staff failed to document that [MEDICATION NAME] had been administered on 8/27/10, 8/29/10 and 8/30/10.", "filedate": "2014-03-01"}
{"rowid": 10598, "facility_name": "CORDELE HEALTH AND REHABILITATION", "facility_id": 115429, "address": "1106 NORTH 4TH STREET", "city": "CORDELE", "state": "GA", "zip": 31015, "inspection_date": "2010-09-01", "deficiency_tag": 463, "scope_severity": "E", "complaint": null, "standard": null, "eventid": "W2R511", "inspection_text": "Based on observations, and resident and staff interviews, it was determined that the facility failed to properly maintain the call light system for seven beds on one of two halls (200). Findings include: 1. During the group interview on 8/30/10 at 1:50 p.m., one resident (\"B\") of the four residents in attendance complained that the call light in his/her room did not always work. During an observation on 9/1/10 at 8:30 a.m., seven of the call lights(rooms 204 bed 3, 203 bed 3, 201 beds 1 and 2 , 219 bed 2, 200 bed 3, 205 bed 3) in residents' rooms on the 200 hall were not working. Residents \"E\" and \"D\" stated that the call lights had not worked correctly for about the last one to two weeks. They stated that sometimes the light would turn on (light up) without either of them pushing the button. They stated that the staff had told them they did not know what was wrong with the call light system. During an interview on 9/1/10 at 9:30 a.m., the Administrator stated that the facility had recently had a problem with a call light on the 100 hall but, she was not aware of any problems with call lights on the 200 hall. She provided documentation on 8/19/10 that the facility had requested another service visit from their contractor for problems with the system in one room on 100 hall and a lot (of rooms) on the North side. According to that request, there had been a service visit on Monday (August16, 2010). Although the facility was aware of problems with the call light system, there was no evidence of continued monitoring of the call light system to determine its operational status. When the administrator contacted the Maintenance Director on 9/11/10 at 9:39 a.m., he confirmed that he had not performed any random checks of the call light system. At 10:20 a.m., the Administrator provided a list of the call lights on the 200 hall that had been checked by the Maintenance Supervisor. He identified two call lights that were not functioning properly. The Administrator reported that the Maintenance Director said that he had found condensation on the call light wires for the two call lights that were malfunctioning. At that time, the Administrator stated that she had contacted the company again to service the call light system and given bells to the residents to use to call for assistance until the call light system was serviced.", "filedate": "2014-03-01"}
{"rowid": 10599, "facility_name": "CORDELE HEALTH AND REHABILITATION", "facility_id": 115429, "address": "1106 NORTH 4TH STREET", "city": "CORDELE", "state": "GA", "zip": 31015, "inspection_date": "2010-09-01", "deficiency_tag": 428, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "W2R511", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, it was determined that the consultant pharmacist failed to identify that the frequency of administering a hypnotic had been changed without a physician's orders [REDACTED]. Findings include Resident #8 had a physician's orders [REDACTED]. However, a review of the resident's June 2010 Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. However, review of the clinical record revealed that there was no evidence of a physician's orders [REDACTED]. During an interview on 8/31/10 at 3:30 p.m., licensed nurse \"AA\" confirmed that there was not a physician's orders [REDACTED]. However, nursing staff administered Ambien to the resident every night in June and July and 30 of 31 nights in August, 2010. Although the consultant pharmacist reviewed the resident's drug regimen in July and August 2010, she failed to identify the change in the the frequency of administration of Ambien without a physician's orders [REDACTED]. See F309 for additional information regarding resident #8.", "filedate": "2014-03-01"}
{"rowid": 10600, "facility_name": "MEADOWBROOK HEALTH AND REHAB", "facility_id": 115561, "address": "4608 LAWRENCEVILLE HIGHWAY", "city": "TUCKER", "state": "GA", "zip": 30084, "inspection_date": "2010-11-17", "deficiency_tag": 202, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "IU2W11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to document the reason for one (1) resident's discharge, Resident #1, from a survey sample of eight (8) residents. Findings include: A review of the medical record for resident #1 revealed the resident was discharged to the hospital on [DATE] due to dangerous aggressive behaviors to others. There was no documentation noted in the medical record by the attending physician or extender as to an inability to meet the resident's needs in the facility or of plans for discharge. A telephone interview conducted on 11/17/10 at 12:26 p.m. with the physician, revealed he had told the discharge planner at the hospital that the resident could not return to the facility because she was dangerous to self and others. The physician further confirmed that he had not documented in the resident's medical record nor had he informed the family that the resident could not return to the facility.", "filedate": "2014-03-01"}
{"rowid": 10601, "facility_name": "MEADOWBROOK HEALTH AND REHAB", "facility_id": 115561, "address": "4608 LAWRENCEVILLE HIGHWAY", "city": "TUCKER", "state": "GA", "zip": 30084, "inspection_date": "2010-11-17", "deficiency_tag": 203, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "IU2W11", "inspection_text": "Based on record review and staff interview the facility failed to issue a discharge notice to the resident and family member of the resdient of the discharge and the reasons for the move in writing for one (1) resident, Resident #1, in a survey sample of eight (8) resdients. Findings include: Based on review of the medical record of resident #1, there was no documentation in the resident's medical record that showed the facility provided a discharge notice as soon as practical to the resident and/or family member as required. This notice should include the reason for the transfer/discharge; the effective date of the transfer or discharge; the location to which the resident was transferred or discharged ; the right of appeal, and how to notify the ombudsman (name, address, and telephone number). During an interview with the administrator on 11/17/2010 at 12:45 p.m., the administrator said he had told the complainant about the injured staff member and said that the resident could not return to the facility. However, the administrator said that this conversation with the family member had not been documented.", "filedate": "2014-03-01"}
{"rowid": 10602, "facility_name": "AUTUMN BREEZE HEALTH CARE CTR", "facility_id": 115580, "address": "1480 SANDTOWN ROAD", "city": "MARIETTA", "state": "GA", "zip": 30008, "inspection_date": "2010-11-17", "deficiency_tag": 224, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "C9BJ11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, record review, and hospital document review, the facility failed to provide the services necessary to assess and obtain timely treatment for one (1) resident (\"C\") from a survey sample of three (3) residents. Findings include: Record review for Resident \"C\" revealed a 04/20/2010 Physician's Admission History and Physical which documented that the resident's breast exam had been deferred. A physician's Progress Note dated 10/25/2010 documented that during the April 2010 History and Physical, the palpation portion of the breast exam had been deferred, but that visualization for asymmetry and assessment for nipple drainage had been unremarkable. Further review of the resident's record revealed documentation indicating that weekly assessments had been done, with no notations indicating that staff had either identified or documented any changes or dimpling of the right breast. However, a Nurse's Note of 10/24/2010 at 6:00 p.m. documented that the resident's family member had reported a lump in the resident's right breast. This Note documented that upon assessment, a lump approximately the size of a golf ball was palpated on the inner portion, and extending toward the middle, of the resident's right breast, with indentation observed. This Note further documented that the physician was notified, and an order was received to send the resident to the hospital emergency room . A hospital ED Record of 10/24/2010 documented that Resident \"C\" was diagnosed with [REDACTED]. A Physician's Progress Note of 10/27/2010 documented that a breast exam had revealed considerable induration with skin retraction. During an interview with the Assistant Director of Nursing (ADON) conducted on 11/17/2010 at 1:20 p.m., she stated that she expected staff to do a head-to-toe assessment and to report any changes or abnormal findings. The ADON stated that she had examined Resident \"C\"'s breasts and noted that the right breast looked different. The ADON further stated that she would have expected staff to have made the appropriate notification regarding this change. However, during an interview with the Regional Clinical Director conducted on 11/17/2010 at 1:50 p.m., she stated that the nurse who had performed the weekly skin assessments had stated that she had not noted any changes. An observation of the resident on 11/17/2010 at 12:05 p.m. revealed that the resident had dimpling of the right breast.", "filedate": "2014-03-01"}
{"rowid": 10603, "facility_name": "CANTON NURSING CENTER", "facility_id": 115606, "address": "321 HOSPITAL ROAD", "city": "CANTON", "state": "GA", "zip": 30114, "inspection_date": "2010-11-30", "deficiency_tag": 309, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "LIVR11", "inspection_text": "**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 administer medications as ordered by the physician for one (1) resident (#1) in a survey sample of six (6) residents. Findings include: Record review for Resident #1 revealed a Social Progress Notes entry of 10/11/2010 which documented that the resident had been admitted to the facility on that date. The resident's admission physician's orders [REDACTED]. However, further record review, to include review of the October 2010 Medication Record, revealed no evidence to indicate that the medication was administered, as ordered and scheduled, on 10/16/2010 at 8:00 a.m., 10/17/2010 at 8:00 p.m., and 10/24/2010 at 8:00 a.m. During an interview with the Director of Nursing (DON) conducted on 11/18/2010 at 1:20 p.m., the DON acknowledged there was no evidence to indicate that the medication doses were administered as ordered. Additional review of the 10/11/2010 physician's orders [REDACTED]. During an interview with the DON at 1:15 p.m. on 11/18/2010, the DON acknowledged there was no evidence to indicate that the medication was administered as ordered.", "filedate": "2014-03-01"}
{"rowid": 10604, "facility_name": "GOLD CITY CONVALESCENT CENTER", "facility_id": 115689, "address": "222 MOORE DRIVE", "city": "DAHLONEGA", "state": "GA", "zip": 30533, "inspection_date": "2009-09-24", "deficiency_tag": 323, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "MGH611", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview the facility failed to ensure that three (3) residents (#6, #9, and #12) of nineteen (19) sampled residents at risk for falls had appropriate safety devices in use. Findings include: Review of the quarterly Minimum Data Set (MDS) for resident #12 dated 7/29/09 revealed the resident had fallen in the past thirty (30) days as well as in the past thirty-one (31) to sixty (60) days. Review of the care plan developed to address the risk for falls revealed the resident had an intervention to have an alarm on her wheelchair. During an observation on 9/23/09 at 2:20 p.m. the resident was observed up in the wheelchair, however, there was no alarm in place. During an interview on 9/24/09 at 9:00 a.m. the Director of Nursing (DON) confirmed that the resident should have an alarm when the resident is in her wheel chair. She further stated that the Certified Nursing Assistant (CNA) responsible for restorative nursing had a book with a list of residents who required alarms and safety devices, and she checks these devices daily for their appropriate use. She added, that the use of an alarm on this resident's wheelchair was not listed in the book and must have been left off. Record review for resident #9 revealed that the resident had a history of [REDACTED]. During an observation on 9/24/09 at 12:58 p.m. and on 9/25/09 at 8:15 a.m. the resident was observed in a high back wheelchair and a self release belt was not in place. An interview on 9/25/09 at 8:15 a.m. with Certified Nursing Assistant (CNA) \"AA\" confirmed that a self release belt was not in place. During an observation on 9/26/09 at 8:50 a.m. the resident was observed in bed and a safety pad was not placed beside the bed. During an interview with Licensed Practical Nurse \"BB\" on 9/26/09 at 9:10 a.m. she confirmed that the safety pad was not beside the bed. During an interview on 9/26/09 at 10:45 a.m. Restorative LPN \"EE\" stated the restorative CNA checks residents restraints, and there was no documentation to indicate that this was being done. Review of the most current quarterly Minimal Data Set (MDS) assessments dated 4/29/09 and 8/07/09 indicated that resident #6 had both short and long term memory problems and moderately impaired daily decision making skills. These assessments also indicated the resident required two persons to assist with transfers and one or two persons for ambulation. The resident's care plan for falls dated 5/08/09 had interventions that included use of a bed alarm. Review of Nurse's Notes dated 6/25/09 at 7:00 p.m. revealed that the resident slid off the bed trying to get into the wheelchair but sustained no injury. There was no documentation as to whether or not the bed alarm sounded during this fall. Review of a Nurse's Note dated 6/26/09 revealed that the interdisciplinary team met concerning the fall and would put a bed alarm on the bed. A Nurse's Notes dated 8/06/09 at 6:30 p.m. indicated that the resident was found lying on the floor and sustained a small red area on the right side of the upper back and a small superficial skin tear to the ring finger. Again, there was no documentation that the bed alarm was in place and functioning. Review of the Nurses's Notes on 8/08/09 revealed that staff was educated on the proper procedure for placing the resident in the bed including the use of alarms and side rails. Nurses's Notes dated 8/22/09 at 1:00 p.m. revealed the resident was found sitting on the floor by the bed. There were no injuries. Review of the Incident/Accident Report dated 8/22/09 indicated that the bed alarm did not sound. This report identified that educating the staff on the use of the bed alarm and monitoring whether the alarm is on or off, as the steps taken to prevent fall recurrence. Nurse's note dated 9/06/09 at 9:50 a.m. revealed that the resident was found lying on the bathroom floor on the right side. The resident sustained [REDACTED]. Review of the Incident/Accident Report dated 9/6/09 revealed that the bed alarm was turned off. Interview with the Director of Nurses on 9/23/09 at 11:05 a.m. revealed that when the fall occurred on 6/25/09 the resident had a tab alarm for the bed and that she was unsure if it was working or not, but they replaced it with a pad alarm for the bed. She indicated that she did not know if the alarm was on or working when the fall occurred on 8/06/09. She did confirm the documentation in the Incident/Accident Report dated 8/22/09, that the bed alarm did not sound when the resident fell , and that in a similar report dated 9/06/09, the alarm was turned off when the resident fell .", "filedate": "2014-03-01"}
{"rowid": 10605, "facility_name": "GOLD CITY CONVALESCENT CENTER", "facility_id": 115689, "address": "222 MOORE DRIVE", "city": "DAHLONEGA", "state": "GA", "zip": 30533, "inspection_date": "2009-09-24", "deficiency_tag": 282, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "MGH611", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview the facility failed to ensure for two(2) residents (#9 & 12) on a sample of nineteen (19) residents, that care plans were followed related to the use of chair alarms, safety floor pad and self release seat belts. Findings include: Record review for resident #9 revealed that the resident fell on [DATE], 5/12/09, 5/16/09, 5/31/09, 6/8/09, 6/12/09, 6/15/09, 7/15/09, 7/20/09, and 8/22/09. The care plan dated 9/3/09 indicated that the resident was at risk for falls and was care planned to have a low bed with a safety pad and a self release belt when the resident is in the wheelchair. During an observation on 9/24/09 at 12:58 p.m. and on 9/25/09 at 8:15 a.m. the resident was observed in a high back wheelchair and a self release belt was not in place. An interview on 9/25/09 at 8:15 a.m. with Certified Nursing Assistant \"AA\" confirmed that a self release belt was not in place. During an observation on 9/26/09 at 8:50 a.m. the resident was observed in bed and a safety pad was not placed beside the bed. During an interview with Licensed Practical Nurse \"BB\" on 9/26/09 at 9:10 a.m. she confirmed that the safety pad was not beside the bed. Review of the comprehensive care plan for resident #12 revealed a care plan was developed to address the risk for falls. The care plan was reviewed in the care plan meeting on 7/27/09. An intervention added on 5/12/09 indicated the resident should have a tab alarm applied to her wheelchair. During an observation on 9/23/09 at 2:30 p.m., the resident was observed up in the wheelchair with no tab alarm in place. During an interview on 9/23/09 at 3:10 p.m. the Minimum Data Set (MDS) Coordinator \"AA\" stated the resident was supposed to have the tab alarm, however, she had no explanation as to why it had not been applied.", "filedate": "2014-03-01"}
{"rowid": 10606, "facility_name": "FORT GAINES HEALTH AND REHAB", "facility_id": 115696, "address": "101 HARTFORD ROAD, WEST", "city": "FORT GAINES", "state": "GA", "zip": 39851, "inspection_date": "2010-11-17", "deficiency_tag": 202, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "9ZTI11", "inspection_text": "**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 a physician documented the necessity of a transfer and discharge from the facility for one resident (#1) of three residents reviewed for transfers/discharges from a total sample of five residents. Findings include: Resident #1 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. There was a physician's orders [REDACTED]. A nurse's note entry on 9/10/10 at 2 p.m. documented the resident as stable upon being transferred by car to Medical Center Barbour psychiatric ward for behavior problems. The nurse wrote that the family was aware and the physician was notified. A social service note dated 9/10/10 described the resident's behavior as having become combative and very agitated. The social service staff noted that the resident was being transferred to the Geripsych unit at Barbour Medical Center and that the family and physician were notified. The resident was discharged from the facility on 9/10/10. The Director of Nursing (DON) stated on 11/17/10 at 1:55 p.m., that the resident's physician and medical director had been contacted by the Assistant Director of Nursing (ADON) about transferring the resident on 9/10/10. The physician stated, on 11/17/10 at 3:05 p.m., that the facility had legitimate concerns about the resident's attempting to leave the facility. However, there was not any documentation by the resident's attending physician or another physician about the specific reason for the resident's immediate transfer and discharge to the Medical Center.", "filedate": "2014-03-01"}
{"rowid": 10607, "facility_name": "FORT GAINES HEALTH AND REHAB", "facility_id": 115696, "address": "101 HARTFORD ROAD, WEST", "city": "FORT GAINES", "state": "GA", "zip": 39851, "inspection_date": "2010-11-17", "deficiency_tag": 203, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "9ZTI11", "inspection_text": "**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, it was determined that the facility discharged on e(#1) of three residents without notifying the resident and the resident's family in writing about the specific reason for the discharge and any of the other required information in a total sample of five residents. Findings include: Resident #1 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. There was a physician's orders [REDACTED]. A nurse's note entry on 9/10/10 at 2 p.m. documented the resident as being transferred to Medical Center Barbour psychiatric ward for behavior problems, the family was aware of it and that the physician had been notified. A social service note dated 9/10/10 described the resident as having become combative and very agitated so, he/she was being transferred to the Geripsych unit at Barbour Medical Center. The note indicated that the resident's family and physician were notified. The resident was discharged from the facility on 9/10/10. The administrator stated on 11/17/10 at 10:10 a.m. that the resident was discharged from the facility for safety concerns. The Director of Nursing stated on 11/17/10 at 1:55 p.m., that the resident was transferred and discharged from the facility because of his/her wandering behaviors. However, there was no documentation in the clinical record that the facility had provided written notice to the resident and his family about the discharge, the reason for the discharge, the effective date of the discharge, the location to which the resident was being discharged , or the resident's right to appeal the action to the State, and provide the State long term care ombudsman's name, phone number or address.", "filedate": "2014-03-01"}
{"rowid": 10608, "facility_name": "FORT GAINES HEALTH AND REHAB", "facility_id": 115696, "address": "101 HARTFORD ROAD, WEST", "city": "FORT GAINES", "state": "GA", "zip": 39851, "inspection_date": "2010-11-17", "deficiency_tag": 205, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "9ZTI11", "inspection_text": "**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, two residents (#1 and #2) of three residents who were transferred out of the facility, their family members were provided written information which specified the duration of the facility's bed hold policy from a total sample of five residents. Findings include: The facility's Admission Agreement included a policy on bed holds. The agreement documented the resident and a family member or legal representative would be given notice of the bed hold option at the time of hospitalization or therapeutic leave. The Social Service Director stated during an interview on 11/17/10 at 2:05 p.m., that the bed hold policy was supposed to be sent with residents during transfers out of the facility. However, she said that she did not know if it was being done. She was not sure who was assigned responsibility for sending out the notices. She stated that if the facility was sending it, should have been documented \"somewhere.\" 1. There was a 9/10/10 physician's orders [REDACTED]. However, there was no evidence to indicate that the resident and family had been given written notice which specified the duration of the facility's bed hold policy at the time he/she left the facility. 2. Resident #2 was hosptalized on [DATE] and again on 10/12/10 due to an acute change in condition. However, there was no evidence that the resident and family were given written notice which specified the duration of the facility's bed hold policy at the time the resident left the facility.", "filedate": "2014-03-01"}
{"rowid": 10609, "facility_name": "FORT GAINES HEALTH AND REHAB", "facility_id": 115696, "address": "101 HARTFORD ROAD, WEST", "city": "FORT GAINES", "state": "GA", "zip": 39851, "inspection_date": "2010-11-17", "deficiency_tag": 407, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "9ZTI11", "inspection_text": "Based on record review and staff interview, it was determined that the facility failed to obtain a physician's order prior to a psychiatric evaluation to determine the appropriateness of inpatient psychiatric care for one resident (#1) from at total sample of five residents. Findings include: A social service note entry dated 9/9/10 documented that a staff person from the geri-psychiatric unit at Barbour Medical Center was at the facility to evaluate resident #1's behavioral problems in order to determine if he/she met the criteria for placement at the geripsychiatric unit.. However, a review of the clinical record revealed that there was not a physician's order for that psychiatric evaluation. The Social Service Director stated on 11/17/10 at 2:05 p.m., that the Director of Nursing told her to contact Barbour Medical Center geri-psychiatric services to evaluate the resident. The resident's physician stated on 11/17/10 at 3:05 p.m. that she was not aware that an (psychiatric) evaluation and had not ordered one to be done.", "filedate": "2014-03-01"}
{"rowid": 10610, "facility_name": "MILLER NURSING HOME", "facility_id": 115039, "address": "206 GRACE ST", "city": "COLQUITT", "state": "GA", "zip": 39837, "inspection_date": "2010-10-19", "deficiency_tag": 157, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "NOYT11", "inspection_text": "**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 immediately consult with the physician and notify the family when there was a significant change in the physical status of one (1) resident (#1) from a survey sample of four (4) residents. Findings include: Record review for Resident #1 revealed the resident's September 2010 Physician order [REDACTED]. An original Admissions Nursing Assessment documented that the resident was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. An Alteration In Skin Integrity Report of 08/28/2010 specifically documented that the resident had a right above-the-knee amputation and a left below-the-knee amputation, but documented no problem related to the left knee. A later Alteration In Skin Integrity Report of 09/04/2010 documented that by that time, bruising and [MEDICAL CONDITION], with discoloration, were noted to the left knee. Additionally, documentation on the September 2010 General Notes indicated that the resident was medicated with [MEDICATION NAME] 5-500 milligrams for specific complaints of pain in the left leg on 09/04/2010 at 3:00 a.m., 09/07/2010 at 4:00 a.m., and 09/08/2010 at 5:30 a.m.. However, further record review revealed no evidence to indicate that the physician and the family were notified about this significant change status of the resident's left knee, as indicated by bruising, discoloration, [MEDICAL CONDITION], and continued complaints of pain, until a Nurse's Note of 09/10/2010 at 2:40 p.m. documented that the nurse was called to the room of the resident by a certified nursing assistant. This Note documented that the nurse noted ischemic skin breakdown to the resident's left knee, and documented that the physician was notified of the observed breakdown at that time. A Nurse's Note of 09/10/2010 at 2:50 p.m. documented that the family was notified. The above was acknowledged by licensed staff member \"AA\" during an interview conducted on 10/13/2010 at 4:45 p.m.", "filedate": "2014-02-01"}
{"rowid": 10611, "facility_name": "TOWER ROAD HEALTHCARE AND REHABILITATION CENTER", "facility_id": 115115, "address": "26 TOWER RD", "city": "MARIETTA", "state": "GA", "zip": 30060, "inspection_date": "2010-10-18", "deficiency_tag": 225, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "DMLD11", "inspection_text": "Based on family interview and staff interview, it was determined that the facility failed to investigate allegations of misappropriation of resident property reported to facility staff by the family of one (1) resident (\"A\") in a survey sample of five (5) residents. Findings include: During an interview with a family member of Resident \"A\" conducted on 10/12/2010 at 3:45 p.m., the family member stated that it had been reported to the Administrator that someone in a white uniform had been observed by the resident standing in front of an opened drawer and had started to pull things out, at which time the resident screamed and the person left the room. The family member stated that another allegation had been reported to the Administrator in which perfume was allegedly stolen from the resident's room. During an additional interview with the family of Resident \"A\" conducted by telephone on 10/14/2010 at 6:15 p.m., the family member alleged that the stolen perfume referenced above was valued at $110.00. The family member also alleged that a pair of earrings had been stolen from the resident's jewelry box, and that this allegation was also reported to the Administrator. During an interview with the Administrator conducted on 10/12/2010 at 4:10 p.m., the Administrator acknowledged that there was an allegation reported by the resident's family of an intruder in the resident's room attempting to steal something, but further acknowledged that neither this allegation, nor the allegation regarding the stolen perfumed, were investigated or reported to the State regulatory agency by the facility. During an additional interview with the Administrator conducted on 10/18/2010 at 11:55 a.m., the Administrator stated that the allegation regarding missing earrings was not investigated or reported to the State survey agency.", "filedate": "2014-02-01"}
{"rowid": 10612, "facility_name": "ANDERSON MILL HEALTH AND REHABILITATION CENTER", "facility_id": 115145, "address": "2130 ANDERSON MILL RD", "city": "AUSTELL", "state": "GA", "zip": 30106, "inspection_date": "2010-10-13", "deficiency_tag": 157, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "Y3K611", "inspection_text": "**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 immediately notify the family of a dislocated right hip arthroplasty for one (1) resident (#1) in a survey sample of four (4) residents. Findings include: Record review for Resident #1 revealed an Accumulative [DIAGNOSES REDACTED]. A physician's note referencing a physician's visit of 08/21/2010 documented that Resident #1 had experienced a dislocation of the right hip and had undergone a closed reduction in the hospital on [DATE], and was then admitted to the nursing facility on 08/20/2010. A Physician's Telephone Order of 08/20/2010 specified that the resident was to have an x-ray of the right hip prior to the a physician's appointment scheduled on 09/17/2010. A Radiology Report dated 09/02/2010 documented that the impression was a dislocation of the right arthroplasty. A Nursing Daily Skilled Summary dated 09/02/2010 at 10:30 p.m. documented that the x-ray result had been received and was positive for a dislocation of the right hip arthroplasty, and that the resident's physician was notified of the results. However, further record review, to include review of the Nursing Daily Skilled Summary, revealed no evidence to indicate that the resident's family had been notified of this resident's significant change in physical status. During an interview with the Director of Nursing (DON) conducted on 10/13/2010 at 11:10 a.m., the DON acknowledged that the resident's family was not notified of the results of the x-ray done on 09/02/2010 that indicated a dislocation of the resident's right hip arthroplasty.", "filedate": "2014-02-01"}
{"rowid": 10613, "facility_name": "ANDERSON MILL HEALTH AND REHABILITATION CENTER", "facility_id": 115145, "address": "2130 ANDERSON MILL RD", "city": "AUSTELL", "state": "GA", "zip": 30106, "inspection_date": "2010-10-13", "deficiency_tag": 309, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "Y3K611", "inspection_text": "Based on record review and staff interview, it was determined that the facility failed to provide care, in accordance with a physician's order for a surgical consultation, for one (1) resident (#1) in a survey sample of four (4) residents. Findings include: Record review for Resident #1 revealed a Physician's Telephone Order of 08/20/2010 which specified that the resident was to have an x-ray of the right hip prior to the a physician's appointment scheduled on 09/17/2010. A Radiology Report dated 09/02/2010 documented that the impression was a dislocation of the resident's right arthroplasty. A Nursing Daily Skilled Summary dated 09/02/2010 at 10:30 p.m. documented that the resident's attending physician had been made aware of the x-ray result which was positive for a dislocation of the right hip arthroplasty, and documented that the attending physician ordered for staff on the 7:00 a.m.-3:00 p.m. shift to follow-up with the surgeon the next morning. However, further record review, to include review of the Nursing Daily Skilled Summary, revealed no evidence to indicate that the surgeon was notified of the x-ray results, as specified by the resident's attending physician's order. During an interview with the Director of Nursing (DON) conducted on 10/13/2010 at 11:10 a.m., the DON acknowledged that the surgeon was not notified of the results of the x-ray, as specified by the attending physician's order.", "filedate": "2014-02-01"}
{"rowid": 10614, "facility_name": "GLENN-MOR NURSING HOME", "facility_id": 115480, "address": "10629  U.S. HIGHWAY 19 SOUTH", "city": "THOMASVILLE", "state": "GA", "zip": 31792, "inspection_date": "2010-08-26", "deficiency_tag": 502, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "S0VI11", "inspection_text": "**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 obtain laboratory tests as ordered for two residents ( #6 and #10) from a total sample of 15 residents. Findings include: 1. Resident #6 had a 4/6/10 pharmacy recommendation for a lipid panel and a HgbA1c now and every 12 months to monitor his/her use of [MEDICATION NAME]. The resident's attending physician approved that recommendation on 5/3/10 and ordered that those laboratory tests be obtained on 5/5/10 and then annually. However, the laboratory tests were not obtained as ordered until 8/25/10, after surveyor inquiry. During an interview on 8/25/10 at 10:50 a.m., licensed nurse \"AA\" confirmed that nursing staff had failed to obtain the laboratory tests as ordered. 2. Resident #10 was admitted on [DATE]. There was an 8/9/10 physician's orders [REDACTED].) and a Liver Function Test (LFT) to be obtained the week of admission and then every 6 months thereafter with a start date of 8/11/10. The order included that a Potassium level was to be obtained the week of admission and then once a month thereafter with a start date of 8/11/10. However, those laboratory tests were not obtained until 8/26/10, after surveyor inquiry. On 8/26/10 at 11:20 a.m., the Director of Nurses provided a copy of the laboratory results and confirmed that those laboratory tests had not been obtained until that day (8/26/10). Resident #10 had a critical high [MEDICATION NAME] time (PT) level of 44 seconds (normal range of 9.5 - 11.8 seconds) and a critical high International Normalized Ratio (INR) of 4.5 ( normal range 2 - 3) on 8/11/10. The physician ordered that nursing staff hold the resident's [MEDICATION NAME] for two days and then recheck the resident's PT and INR levels again on 8/13/10. However, nursing staff failed to obtain the PT and INR levels until 8/16/10. On 8/16/10, the laboratory results form noted that the resident's PT was high at 17 seconds and the physician was notified.", "filedate": "2014-02-01"}
{"rowid": 10615, "facility_name": "GLENN-MOR NURSING HOME", "facility_id": 115480, "address": "10629  U.S. HIGHWAY 19 SOUTH", "city": "THOMASVILLE", "state": "GA", "zip": 31792, "inspection_date": "2010-08-26", "deficiency_tag": 253, "scope_severity": "D", "complaint": null, "standard": null, "eventid": "S0VI11", "inspection_text": "Based on observations, it was determined that the facility failed to maintain an environment that was free from dust, dirt, improperly fitting vents, stained ceiling tiles, missing light bulbs and light covers and broken air conditioner vent covers in nine of 31 residents' rooms on both halls (100 and 200) of the facility. Findings include: Observations were made on 8/24/10 between 9:30 a.m. and 10:35 a.m. 100 Hall 1. The bathroom's ceiling tiles did not fit so, there were gaps in the ceiling in room 108. 2. There were two dried brown stained ceiling tiles in room 103. 200 Hall 1. There was a dried brown stained ceiling tile in the bathrooms in rooms 201 and 212. 2. The bathroom ceiling light fixture was missing a bulb and light cover in room 205. 3. The air conditioner vent covers had a build up of dust in rooms 207, 209, 211 and 214. 4. The bathroom's ceiling vent was loose in room 209. 5. A part of the air conditioner's plastic vent cover was broken off in room 207.", "filedate": "2014-02-01"}