cms_GA
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| Link | rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid ▼ | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 8457 | 8457 | HEART OF GEORGIA NURSING HOME | 115471 | 815 LEGION DRIVE | EASTMAN | GA | 31023 | 2009-09-30 | 225 | D | 0 | 1 | Deficiency Text Not Available | 2016-01-01 | |
| 8458 | 8458 | HEART OF GEORGIA NURSING HOME | 115471 | 815 LEGION DRIVE | EASTMAN | GA | 31023 | 2009-09-30 | 279 | D | 0 | 1 | Deficiency Text Not Available | 2016-01-01 | |
| 8459 | 8459 | HEART OF GEORGIA NURSING HOME | 115471 | 815 LEGION DRIVE | EASTMAN | GA | 31023 | 2009-09-30 | 309 | D | 0 | 1 | Deficiency Text Not Available | 2016-01-01 | |
| 8460 | 8460 | HEART OF GEORGIA NURSING HOME | 115471 | 815 LEGION DRIVE | EASTMAN | GA | 31023 | 2009-09-30 | 314 | D | 0 | 1 | Deficiency Text Not Available | 2016-01-01 | |
| 8461 | 8461 | HEART OF GEORGIA NURSING HOME | 115471 | 815 LEGION DRIVE | EASTMAN | GA | 31023 | 2009-09-30 | 322 | D | 0 | 1 | Deficiency Text Not Available | 2016-01-01 | |
| 8462 | 8462 | HEART OF GEORGIA NURSING HOME | 115471 | 815 LEGION DRIVE | EASTMAN | GA | 31023 | 2009-09-30 | 371 | F | 0 | 1 | Deficiency Text Not Available | 2016-01-01 | |
| 7219 | 7219 | SAVANNAH BEACH HEALTH AND REHAB | 115633 | 26 VAN HORNE STREET | TYBEE ISLAND | GA | 31328 | 2014-07-12 | 280 | D | 1 | 0 | 0.0 | Based on record review, family and staff interviews, facility failed to consistently invite five (5) residents t (X, Z, #3, #4, and #5) and/or family to quarterly care plan meetings from a sample of seven (7) residents. Findings include: 1. Review of the Interdisciplinary Care Plan Conference Sheet for resident X dated 5/15/14 revealed no evidence that the resident and/or family had been invited and/or attended the care plan meeting. Further review of the Point Click Care Social Worker Notes revealed no evidence that the daughter was invited to the 5/15/14 care plan meeting. Interview with the daughter of resident X on 7/11/14 at 6:38 p.m., revealed that she had not been to a care plan (CP) meeting for over nine (9) months. 2. Review of the Interdisciplinary Care Plan Conference Sheet for resident Z dated 2/27/14 and 5/1/14 revealed no evidence that the resident and/or family were invited and/or attended the care plan meeting. Further review of the Point Click Care Social Worker Notes since admission in January, 2014 revealed no evidence that the resident and/or family was invited to the quarterly CP meetings. Interview with the daughter of resident Z on 7/12/14 at 10:20 a.m., revealed that she has never been invited to attend a CP meeting, either by phone and/or by mail, since her mother's admission to the facility. Continued interview revealed that she goes to the facility staff to find out how her mother is doing and asks any questions about her mothers care. 3. Review of the Interdisciplinary Care Plan Conference Sheet for resident #3 dated 4/3/14 and 6/19/14 revealed no evidence that the resident and/or family was invited and/or attended CP meeting. Further review of the Point Click Care Notes from March 2014-Present revealed no evidence that the resident and/or family being invited and/or attending CP meeting. 4. Review of the Interdisciplinary Care Plan Conference Sheet for resident #4 dated 9/19/13, 12/12/13, 3/7/14, and 6/12/14 revealed no evidence that the resident and/or family was invited and/or atten… | 2017-07-01 |
| 6591 | 6591 | PRUITTHEALTH - MOULTRIE | 115505 | 233 SUNSET CIRCLE | MOULTRIE | GA | 31768 | 2014-03-06 | 364 | F | 0 | 1 | 00HK11 | Based on observation, resident interview and record review the facility failed to maintain food temperatures within the acceptable level (135 degrees) for hot foods and cold foods (40 degrees) during food service for two (2) meals of the three (3) meals observed during the survey. Findings include: Observation on 3/3/14 at 12:25 p.m revealed that during the food service, temperatures were acquired by the dietary manager at the request of the surveyor and were as follows: Puree sweet and sour pork was 130 degrees Fahrenheit (F) Puree stir-fry vegetables were 130 degrees F Beef tips in regular form were 130 degrees F All of these foods were being held on the steam table and the steam table was on maximum. Observation on 3/3/14 at 12:25 p.m. revealed that the milk in individual cartons was tested at 50 degrees by the dietary manager and had been sitting on a tray to be served. Observation on 3/5/14 at 12:35 p.m. revealed the facility was serving a menu that included salmon patty and creamed corn. Observation during the food service at this time revealed that food temperatures were acquired by the dietary manager of these items on the stream table for puree creamed corn and the Salmon patties were held under a heat light: Salmon patty was 112 degrees F Puree corn was 130 F An interview with the dietary manager on 3/5/14 at 1:20 p.m. revealed that she knew food temperatures should be 135 degrees or greater for hot foods. She further stated that at supper on 3/5/14 she would keep checking temperatures and if temperatures were not holding, she would move everything to the stove and serve from there. She revealed that there was no temperature log for 3/5/14 lunch meal but stated the salmon patties were 140 degrees at the beginning of service; although there was no documentation to verify this information. An interview with the dietary manager on 3/5/14 at 2:30 p.m. revealed that plates are warmed in a plate warmer and there were domed lids for the plates that were being taken to resident's rooms. In an interview with the… | 2017-11-01 |
| 6592 | 6592 | PRUITTHEALTH - MOULTRIE | 115505 | 233 SUNSET CIRCLE | MOULTRIE | GA | 31768 | 2014-03-06 | 371 | F | 0 | 1 | 00HK11 | Based on observation and staff interview the facility failed to properly store food to prevent foodborne illness. Findings include: Observation on 3/3/13 at 12:30 p.m. revealed the following observations were made in the dietary kitchen: 1. On the shelf under the preparation table there was one (1) bottle of lemon juice that was 3/4 full. The date written on the label was 9/2/12. Dietary manager was unable to state what the date represented,. The label clearly stated to refrigerate after opening. The sediment in the bottle was thick and coarse. 2. In the reach-in cooler in the right side there were gallon pitchers of cranberry juice(1), orange juice(1), and apple juice(1). The pitchers were dirty in appearance with a heavy build up of dried spills on the sides. The lids were in place with labels stating use daily. There were no dates in place relevant to when the juices were opened, made or expired. There was one gallon pitcher of tea also in the cooler with dried spills and a lid in place labelled with use daily. 3. Further observation on the left side of the cooler was found one (1) tall round plastic container with lid in place with a label stating cranberry sauce: with in 2/22 - out 2/27. In an interview on 3/6/14 at 9:35 a.m. with staff AA revealed that the pitchers are emptied , washed and fresh juice made daily. | 2017-11-01 |
| 6493 | 6493 | CORDELE HEALTH AND REHABILITATION | 115429 | 1106 NORTH 4TH STREET | CORDELE | GA | 31015 | 2014-02-13 | 312 | D | 0 | 1 | 01DX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review and staff interviews the facility failed to ensure that (1) resident ( E) who required assistance with grooming, was observed with her hair uncombed for two of four (2/4) days of the survey from a sample size of twenty-eight (28) residents. Findings include: Review of the clinical record for resident E reveals the resident is a ninety-one (91) year old African American resident admitted to the facility since 2012. She is alert, pleasantly confused with a Brief Interview (BIMS) score of five (5). Review of the Quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed that the resident was assessed as being always continent of bowels and bladder. She required limited assistance of one (1) person with dressing, personal hygiene, and physical help with bathing. Continued review revealed that the resident was independent with bed mobility, transferring, ambulating, locomotion, eating and toileting. Review of the resident's care plan revealed there was a care plan dated 07/31/12 for requiring minimal assistance with activities of daily living (ADLs) related to weakness in her lower extremities, and impaired cognition. Noted on 09/02/13 that the resident refuses mouth and nail care at times. The interventions included to assist daily with grooming, dressing, and oral care, and to encourage the resident to participate in ADLs to her ability. Review of the Resident Bath List revealed that resident E receives a bath every Monday, Wednesday, and Friday. Observation of resident E on 02/10/14 at 1:00 p.m. ambulating independently in the hallway. She was appropriately dressed, her hair was disheveled with braids that were uncombed. The resident was pleasantly confused and ambulated the hallway holding a towel. Observation of resident E on 02/11/14 at 10:55 a.m. ambulating from her room to the dining room for morning exercises with Certified Nursing Assistant (CNA) CC. She was appropriately dressed, her hair was … | 2017-12-01 |
| 6494 | 6494 | CORDELE HEALTH AND REHABILITATION | 115429 | 1106 NORTH 4TH STREET | CORDELE | GA | 31015 | 2014-02-13 | 328 | D | 0 | 1 | 01DX11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interviews the facility failed to ensure that oxygen therapy equipment was maintained in a sanitary manner for three (3) residents (#14, #22, #36) receiving continuous oxygen therapy for four of four (4/4) days of the survey from a sample of twenty-eight (28) residents. There were thirteen (13) residents in the facility that received oxygen therapy, eight (8) of the thirteen (13) residents received continuous oxygen therapy daily. Findings include: Review of the clinical record for Resident # 14 reveals the resident is a seventy-one (71) year old long term care resident with a [DIAGNOSES REDACTED].@ 2L/min) via nasal cannula (N/C). Observation of resident # 14 on 02/10/14 at 2:06 p.m. revealed the resident lying in bed with (O2) therapy by N/C in progress, the tubing was observed lying beside her on the bed, no respiratory distress observed. The O2 concentrator was located on the floor next to the bed set to 2L/min. The filters located on both sides of the concentrator were covered in lint. The nebulizer machine was located on top of her personal refrigerator; the mask and tubing were bagged. Observation of resident # 14's room on 02/11/14 at 11:00 a.m. revealed that the resident was out to her [MEDICAL TREATMENT] treatment. The oxygen concentrator was observed on the floor next to the bed. The air filters located on both sides of the concentrator was covered in lint. The nebulizer equipment was bagged at the bedside. Observation of resident # 14 on 02/11/14 at 3:30 p.m., in her room the resident had just returned from [MEDICAL TREATMENT] and was being cared for by staff. The resident appeared tired with O2 therapy via n/c in place. The oxygen concentrator filters were still dirty and covered in lint. Observation of resident # 14 on 02/12/14 at 10:00 a.m. revealed the resident well groomed with her hair combed lying in bed. The oxygen tubing n/c was observed under her chin, not in her nose, no lab… | 2017-12-01 |
| 405 | 405 | HARBORVIEW SATILLA | 115265 | 1600 RIVERSIDE AVE | WAYCROSS | GA | 31501 | 2017-04-06 | 371 | F | 0 | 1 | 01P811 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, and review of policy titled, Food Safety Standards and Requirements Facility A failed to assure that items were labeled and dated and items were used before the expiration date in two (2) reach in coolers in the kitchen and in two (2) of two (2) refrigerators in the resident food pantry. The facility also failed to assure that temperature logs were kept for freezer temperatures in two (2) of two (2) resident pantry. Facility B failed to label and date opened food items before storage in the walk-in freezer and failed to label and securely close one open food item in a walk-in dry good storage pantry to prevent cross contamination from environment debris. Facility A failed to label, date, and properly store food items in one refrigerator, discard of expired and label food item in nourishment refrigerator on East Hall and West Hall pantries, and to ensure all food items are stored at the appropriate temperature by placing a therometer in the freezer. This deficient practice had the potential to effect 2 two of 2 two pantry at the facility A and both kitchens. Total census of 162 with nine 9 tube feeders. A total census of 162. Findings forinclude: Facility A Observation during the initial tour on 4/3/17 at 9:35 a.m.of Facility A revealed the clear reach in cooler had one container of Silk Almond Milk (one quart) that did not have an open date with directions of stay fresh 7-10 days after opening. There was one (1) open container (no open date) of Nectar like consistency - Sweetened tea with lemon flavor (46 fluid ounces (fl. oz.)) with directions of refrigerate up to 7 days once opened. There was one half bag of Texas toast that did not have an expiration date or an open date on the bag. During kitchen tour on 4/5/17 at 12:19 p.m. of Facility A in the silver reach in cooler there was one container labeled to have black olives and had an opened date of 2/27/17 and a use by date of 3/6/17. There was also a f… | 2020-09-01 |
| 1151 | 1151 | SOUTHLAND HEALTHCARE AND REHAB CENTER | 115376 | 606 SIMMONS ST | DUBLIN | GA | 31040 | 2019-08-26 | 656 | D | 1 | 0 | 01RO11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and staff interview, the facility failed to administer an as needed pain medication as care planned for one of seven sampled residents (R) (A). Findings include: RA had a current care plan since at least 3/1/19 for pain related to history of chronic pain, drug seeking behaviors and [MEDICAL CONDITION]. The care plan included an intervention for licensed nursing staff to administer medications as indicated. Review of the 7/2019 physician's orders [REDACTED]. Review of the 7/2019 Medication Administration Record [REDACTED]. Further review revealed the resident did not receive any pain medicine on 7/26/19, 7/27/19 and 7/28/19. Review of the Controlled Substances Proof of Use record for 7/2019 revealed the resident's last dose of pain medicine was given on 7/25/19 at 5:00 a.m. The next dose was given on 7/29/19 at 9:00 p.m. During an interview with RA on 8/21/19 at 1:30 p.m., she stated that she has gone one day here and one day there without her pain medicine. She stated that the staff told her the pharmacy did not deliver the medication. She stated on the days she did not get her pain medicine, she was in a lot of pain and she was crazy and mean. She also stated that she has to take the pain medicine every day or the pain in her back and legs is terrible. Cross refer to F684. | 2020-09-01 |
| 1152 | 1152 | SOUTHLAND HEALTHCARE AND REHAB CENTER | 115376 | 606 SIMMONS ST | DUBLIN | GA | 31040 | 2019-08-26 | 684 | D | 1 | 0 | 01RO11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and staff interview, the facility failed to ensure that licensed/registered nursing staff reordered an as needed(PRN) pain medication timely prior to running out of the medication for one resident (R) (A) from a sample of seven residents. Findings include: Record review for R A revealed she was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the Quarterly Minimum Data Set ((MDS) dated [DATE] revealed that the resident had pain present occasionally with moderate intensity and received an opioid daily. Review of the 7/2019 physician's orders [REDACTED]. Review of the 7/2019 Medication Administration Record [REDACTED]. Further review revealed the resident did not receive any pain medicine on 7/26/19, 7/27/19 and 7/28/19. Review of the Controlled Substances Proof of Use record for 7/2019 revealed the resident's last dose of pain medicine was given on 7/25/19 at 5:00 a.m. The next dose was given on 7/29/19 at 9:00 p.m. During a telephone interview with Pharmacy Technician BB on 8/21/19 at 1:00 p.m., she stated the pain medicine was not reordered until 7/27/19 and the pharmacy sent the medicine on 7/29/19. During an interview with RA on 8/21/19 at 1:30 p.m., she stated she has gone one day here and one day there without her pain medicine. She stated the staff told her the pharmacy did not deliver the medication. She stated on the days she did not get her pain medicine, she was in a lot of pain and she was crazy and mean. She also stated that she has to take the pain medicine every day or the pain in her back and legs is terrible. | 2020-09-01 |
| 1153 | 1153 | SOUTHLAND HEALTHCARE AND REHAB CENTER | 115376 | 606 SIMMONS ST | DUBLIN | GA | 31040 | 2019-08-26 | 725 | D | 1 | 0 | 01RO11 | > Based on record review and staff interview, the facility failed to ensure there was adequate licensed nursing staff present to ensure 20 residents on one of five halls received prescribed medications. Findings include: Review of the Daily Assignment Sheet for 5/5/19 revealed there were two nurses scheduled for the 7:00 a.m.-7 p.m. shift. Further review of the assignment sheet revealed there was not a licensed nurse assigned to the [NAME] Hall. Review of the 5/10/19 five-day follow-up for the incident on 5/5/19 revealed the following: On 5/5/19 there was a failure by staff to administer ordered medications to residents residing on the [NAME] Hall due to a staffing issue. The Director of Nursing (DON) had been working on securing a 7 a.m. - 7 p.m. nurse to be a medication cart nurse for the shift in question. The weekend Registered Nurse (RN) supervisor had contacted the DON regarding the staffing for 5/5/19 and was told by the DON that she was still working on it. The DON was not successful in securing a nurse to cover the [NAME] Hall. She did not notify administration of not having the staffing coverage, nor did she go to the facility and assist the on-site staff. The on-site Licensed Practical Nurse (LPN) and RN House Supervisor did not attempt to administer medications or check on resident conditions due to missed medications. Both the LPN and the RN were terminated. The DON was suspended. The document noted the facility was in the termination process with the DON as well. The document noted there were 20 residents affected by this incident. All resident's responsible parties were notified. All Attending Physicians were notified, and the Medical Director was notified. All residents were monitored for 72 hours for any signs and symptoms of distress, or possible negative impact of missing the dose(s) of medication. Observation/monitoring was documented on a separate Medication Administration Record [REDACTED]. Staff was educated regarding properly notifying administrative staff should senior nursing managers/di… | 2020-09-01 |
| 1154 | 1154 | SOUTHLAND HEALTHCARE AND REHAB CENTER | 115376 | 606 SIMMONS ST | DUBLIN | GA | 31040 | 2019-08-26 | 867 | F | 1 | 0 | 01RO11 | > Based on record review and staff interview, the facility failed to implement an appropriate plan of action to correct an identified quality deficiency related to inadequate staffing causing 20 residents not to receive prescribe medications on 5/5/19. Findings include: Review of the 5/10/19 five-day follow-up letter to the 5/5/19 incident revealed 20 residents on the [NAME] Hall did not receive ordered medications on 5/5/19 due to the Director of Nursing failing to ensure there was a nurse scheduled for the [NAME] Hall on the 7 a.m. - 7 p.m. shift. During an interview with the Nurse Consultant and the Regional Vice President on 8/26/19 at 1:35 p.m., they stated that after the 5/5/19 incident, the previous Administrator initiated a Quality Assurance Performance Improvement (QAPI) AD H[NAME] plan after numerous requests. Review of the QAPI AD H[NAME] provided by the facility revealed there was no date when the plan was developed. The QAPI AD H[NAME] identified the issue as being falsification of documentation. There was no evidence the facility identified inadequate staffing as the root cause of the 5/5/19 incident. Review of the 6/28/19 QAPI Committee meeting minutes revealed the meeting was for (MONTH) and June. There was no evidence the 5/5/19 incident was discussed during the meeting and no plan was put in place to address the problem. During an interview with the Nurse Consultant on 8/26/19 at 1:35 p.m., she confirmed there was no evidence the 5/5/19 incident was discussed in the QAPI meeting for 6/28/19. Cross refer to F725. | 2020-09-01 |
| 4035 | 4035 | CAMBRIDGE POST ACUTE CARE CENTER | 115771 | 2020 MCGEE ROAD | SNELLVILLE | GA | 30078 | 2019-01-25 | 609 | D | 1 | 0 | 01SH11 | > Based on record review and staff interviews, review of the facility's Abuse Prevention Policy', revised 3/1/18, review of the 'Grievance/Complaint ' form revised 1/18/10 and review of the 'Grievance Log' entries beginning (MONTH) (YEAR) through (MONTH) 2019 revealed the facility failed to ensure that an allegation of physical abuse was reported to the State Agency (SA) for one Resident (R) (R#1). The sample size was ten residents. Findings include: Record Review revealed a 'Grievance/Complaint Form' was completed on 11/11/18 by the Director of Nursing in response to a complaint sent by R#1's family via e-mail to the Administrator on 11/11/18 at 2:23 p.m. alleging possible physical abuse of R#1. The completed 'Grievance/Complaint Form' documented the investigation of the allegation including resident and staff interviews and written statements obtained from staff. The allegation was not substantiated. Interview and review of the 'Grievance/Complaint Form' for R#1 on 1/8/19 at 2:38 p.m. with the Director of Nursing (DON) who confirmed that she was aware of the incident, had conducted the investigation, and was confident that no abuse had occurred. Review of the 'Facility Incident Report Form's revised 2/17/17 revealed no record that a report had been filed with the SA related to the allegation of abuse for R#1 dated 11/11/18. Interview and document review on 1/10/19 at 6:45 p.m. with the DON and the Administrator who confirmed that the incident had not been reported to the SA in accordance with federal regulations. The administrator confirmed he is the abuse coordinator for the facility and that he forwarded the allegation of abuse to the DON upon receipt of the allegation and it was investigated. The incident was not reported to the SA because abuse was not found and the police were not notified. | 2020-09-01 |
| 4036 | 4036 | CAMBRIDGE POST ACUTE CARE CENTER | 115771 | 2020 MCGEE ROAD | SNELLVILLE | GA | 30078 | 2019-01-25 | 677 | D | 1 | 0 | 01SH11 | > Based on record review, resident and family interview and staff interview, the facility failed to provide timely adl care to ensure that the needs of five of 98 residents (R), (R#2, R#3, R#4, R#5 and R#6) were met for the residents to achieve the highest practicable level of well-being. This includes residents who are continent or mostly continent of bowel and bladder not receiving assistance to and from toileting facilities in a timely manner, not receiving fresh ice and water routinely across shifts. Facility census was 130. Findings include: `. Interview 1/8/19 at 8:30 a.m. outside of the facility with the son of R#5 who revealed that his mother voiced complaints to him frequently about having to wait for staff to help her to the bathroom. He also stated that when he has been visiting it has taken staff longer than 40 minutes to answer call lights and that weekends and evenings seem to be the worst. He confirms that his mother is 'mostly continent' and has not observed staff asking her if she needs assistance. She is able to voice her needs and doesn't ask for much assistance. Her water is frequently warm and almost empty. He has stated his concerns to the nurses and other staff but has never filed a formal complaint. He sees a lot of staff work double shifts and believes that may affect their ability to care for the residents. R#5's most recent Minimum Data Set (MDS) Quarterly Assessment, dated 10/30/18, Section C: Cognitive Status, revealed a Brief Interview of Mental Status (BIMS) score of nine, indicating mild cognitive impairment. Review of Section G: Functional Status revealed that R#5 requires extensive one-person assistance for toileting and Section H: Bowel and Bladder, subsections H0300 and H0400 reveal that she is occasionally incontinent of bowel and bladder. Section H Bowel and Bladder, subsection H0200, Urinary Toileting Program reveals that resident was on a toileting program beginning 3/14/18. This was discontinued on or about 8/17/18 and restarted 1/7/19. Review of resident assessments revea… | 2020-09-01 |
| 7238 | 7238 | EARLY MEMORIAL NURSING HOME | 115271 | 11740 COLUMBIA ROAD | BLAKELY | GA | 39823 | 2012-07-26 | 156 | C | 0 | 1 | 01VM11 | Based on review of the liability notices issued to residents, who had been discharged from Medicare Part A services, it was determined that the facility failed to issue a Notice of Provider Non-Coverage (CMS form ) to notify residents of their right to an expedited review by the Quality Improvement Organization (QIO) and failed to document a reason for discharge on the Skilled Nursing Facility Advance Beneficiary Notice (CMS form ) for three residents (#99, #28 and #76) in a sample of three residents. Findings include: 1. Resident #99 was issued a CMS form on 6/27/12. However, that notice did not describe the Medicare Services that had been provided, an estimated cost for the continuation of those services and the date of expected discharge from Medicare Part A services. There was only documentation of the cost for room and board and a total cost for PT, OT, ST. There was no evidence that a CMS form had been issued to the resident of his/her right to an expedited review by the QIO. 2. Resident #28 was issued a CMS form on 7/16/12. However, that notice did not describe the Medicare services that had been provided, an estimated cost for the continuation of those services and the date of the expected discharge from Medicare Part A services. There was only documentation of the cost of room and board and a cost amount for PT and OT. There was no evidence that a CMS form had been issued to the resident of his/her right to an expedited review by the QIO. 3. Resident #76 was issued a CMS form on 7/02/12. However, that notice did not describe the Medicare services that had been provided, an estimated cost for the continuation of those services and the date of the expected discharge from Medicare Part A services. There was only documentation of the cost of room and board. There was no evidence that a CMS form had been issued to the resident of his/her right to an expedited review by the QIO. | 2017-06-01 |
| 7239 | 7239 | EARLY MEMORIAL NURSING HOME | 115271 | 11740 COLUMBIA ROAD | BLAKELY | GA | 39823 | 2012-07-26 | 166 | D | 0 | 1 | 01VM11 | Based on interviews with a resident and staff and review of the facility's grievance file, it was determined that the facility failed to make prompt efforts to resolve grievances for one resident (B) and a random family member of a resident in a total sample of 28 residents. Findings include: During an interview on 7/24/12 at 10:28 a.m., resident B said that when he/she used the call light to request staff assistance while they were serving meal trays, the staff had told him/her that the certified nursing assistants (CNAs) could not assist because, they were serving meal trays. The resident said that when he/she had questioned that reason with a nurse and CNA, the CNA told the nurse that the meal trays came first. The resident said that the nurse stated that was not right but, nothing had changed. On 7/25/12 at 5:10 p.m., resident B stated that the previous night he/she had used his/her call light to request staff assistance but was again told that the trays were being served so, the CNAs would come later. A review of the facility's grievance file revealed that the resident's family member had complained to staff on 7/19/12 that when resident B called for assistance to go to the bathroom, it took a long time for staff to respond. Nursing staff documented that action taken to prevent further occurrence was that a 7/19/12 nursing in-service was held about monitoring CNA staff for toileting and response times to call lights. The Social Service staff had signed that the person making the complaint had been informed of the results on 7/23/12. However, when documentation about that in-service was requested, the Director of Nursing stated that the in-service had not been completed but it had been rescheduled for 8/02/12. Therefore, there was no evidence that the facility had made prompt efforts to resolve the resident's grievance. | 2017-06-01 |
| 7240 | 7240 | EARLY MEMORIAL NURSING HOME | 115271 | 11740 COLUMBIA ROAD | BLAKELY | GA | 39823 | 2012-07-26 | 279 | E | 0 | 1 | 01VM11 | Based on observations, record reviews and interviews with residents and staff, it was determined that the facility failed to develop a care plan to address the personal hygiene needs of three residents (A,C, and #60) and the services needed to address the limitations in range of motion for one resident (#15) from a total sample of 28 residents. Findings include: 1. Staff coded resident #15 on his/her 4/30/12 quarterly Minimum Data Set (MDS) assessment as having had limitations in one upper extremity and both lower extremities. The resident had a restorative (nursing) care flow record for nursing staff to do passive range of motion exercises to his/her bilateral upper extremities every day. However, a review of the Restorative Care Flow Record revealed that the range of motion exercises had not been done for eight of 30 days in June 2012 and seven of 24 days in July 2012. Although the facility staff had identified the limitations in the resident's arm and legs, the facility failed to develop a plan of care to address the services to be provided to maintain the resident's range of motion. See F318 for additional information regarding resident #15. 2. Resident C was coded by the facility on the 5/15/12 significant change MDS assessment as needing total assistance from staff for personal hygiene. Although the resident had a plan of care since 9/15/11 to address the need for staff assistance with all activities-of-daily living (ADLs), there were no interventions developed to address the resident's needs for assistance with oral care and shaving. See F312 for additional information regarding resident C. 3. Resident #60 was coded by the facility on the 7/6/12 quarterly MDS assessment as needing total assistance from staff for personal hygiene. Although the resident had a plan of care since 8/18/11 for having a self care deficit for ADLs, there were not any interventions developed to address the resident's needs for assistance with oral care. See F312 for additional information regarding resident #60. | 2017-06-01 |
| 7241 | 7241 | EARLY MEMORIAL NURSING HOME | 115271 | 11740 COLUMBIA ROAD | BLAKELY | GA | 39823 | 2012-07-26 | 280 | D | 0 | 1 | 01VM11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff interview and record review, it was determined that the facility failed to revise the care plan to address the restorative nursing services needed for two residents (#96 and #86) in a total sample of 28 residents. Findings include: 1. Resident #96 was admitted to the facility on [DATE]. There was a 5/07/12 Rehabilitation and Restorative Nursing Program Referral for the resident to be referred to the Restorative Nursing Program, and to receive services which included active range of motion exercises of two (2) sets of twenty (20) repetitions to the lower extremities, and the application of a TENS unit to the resident's back for one (1) hour. However, review of the care plan for Resident #96 revealed that it had not been revised to include the provision of Restorative Nursing Program services for active range of motion exercises, and the application of the TENS unit. During an interview on 07/26/2012 at 1:20 p.m., the Assistant Director of Nursing (ADON) acknowledged that the resident's care plan had not been revised to include the Restorative Nursing Program services. See F318 for additional information regarding resident #96. 2. Resident #86 was admitted to the facility on [DATE]. There was a 3/28/12 Rehabilitation and Restorative Nursing Program Referral form with documentation that the resident was referred to the Restorative Nursing Program for services which included range of motion exercises and strengthening. The documented goal was for the resident to receive active range of motion exercises of twenty (20) repetitions for the bilateral lower extremities daily. However, review of the resident's care plan revealed that it had not been revised to include the resident's Restorative Nursing services for active range of motion exercises. During an interview on 7/26/12 at 1:20 p.m., the ADON acknowledged that the resident's care plan had not been revised to include the Restorative Nursing Program services. See F31… | 2017-06-01 |
| 7242 | 7242 | EARLY MEMORIAL NURSING HOME | 115271 | 11740 COLUMBIA ROAD | BLAKELY | GA | 39823 | 2012-07-26 | 282 | D | 0 | 1 | 01VM11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview and record review, it was determined that the facility failed to implement an intervention for nutritional evaluations to be done by the Registered Dietician for one resident (#76), who had a potential for weight fluctuations, in a total sample of 28 residents. Findings include: Resident # 76 was admitted on [DATE] with [DIAGNOSES REDACTED]. There was a care plan since 11/01/11 to address the resident's potential for fluctuation in weight related to [MEDICAL TREATMENT] and a [DIAGNOSES REDACTED]. There was an intervention for the Registered Dietician to evaluate and follow up at least monthly. However, a review of the resident's medical record revealed [REDACTED]. During an interview on 7/26/12 at 11:30 a.m., the dietary manager provided written assessments done by her for 3/20/12 and 6/2/12 but, there was only one evaluation by the Registered Dietician dated 4/11/12. | 2017-06-01 |
| 7243 | 7243 | EARLY MEMORIAL NURSING HOME | 115271 | 11740 COLUMBIA ROAD | BLAKELY | GA | 39823 | 2012-07-26 | 312 | E | 0 | 1 | 01VM11 | Based on observations, interviews with resident and staff, and record review, it was determined that the facility failed to provide oral care needed for three residents (A, C, and #60) and required assistance with shaving for two residents (A and C) in a total sample of 28 residents. Findings include: 1. Resident C was coded by the facility on the 5/15/12 significant change Minimum Data Set (MDS) assessment as needing total assistance from staff for personal hygiene. Although the resident had a plan of care since 9/15/11 to address the need for staff assistance for all activities-of-daily living (ADLs), there were no interventions developed to address the resident's assistance needs for oral care and shaving. On 7/23/12 at 2:45 p.m., the resident was observed to have a thick mucus film that covered his/her top to bottom teeth and bubbled when he/she spoke. There was a patch of dried, crusty sputum on the corner of the mouth. The resident said that staff had not cleaned his/her mouth that day. The resident had several days growth of facial hair and a thick, untrimmed mustache. The resident stated that staff had not trimmed his/her mustache but he/she would like for it to be trimmed. On 7/25/12 at 9:25 a.m., the resident was observed to have a thick yellow substance caked along the entire length of both of his/her lips. The resident covered his/her mouth before speaking. During an interview on 7/26/12 at 11:10 a.m., certified nursing assistant (CNA) XX confirmed that the resident was completely dependent on staff for shaving and oral care. 2. Resident #60 was coded by the facility on the 7/06/12 quarterly MDS assessment as needing total assistance from staff for personal hygiene. Although the resident had a plan of care since 8/18/11 for having a self care deficit for ADLs, it did not include interventions to address assistance with oral care. On 7/24/12 at 9:35 a.m., the resident was noted to have strong halitosis (bad breath). A review of the July 2012 Aides' Record revealed no evidence that nursing staff had pro… | 2017-06-01 |
| 7244 | 7244 | EARLY MEMORIAL NURSING HOME | 115271 | 11740 COLUMBIA ROAD | BLAKELY | GA | 39823 | 2012-07-26 | 318 | E | 0 | 1 | 01VM11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview and record review, it was determined that the facility failed to consistently provide planned interventions for three residents (#96, #86 and #15) needing restorative services for range-of-motion exercises and/or pain management in a total sample of 28 residents. Findings include: 1. Resident #96 was admitted to the facility on [DATE]. In the Problem/Assessment section of the 5/7/12 Restorative Nursing Program Restorative Referral form, there was documentation that the resident had decreased strength and ambulation, and low back pain. The documented goal was to provide active range of motion exercises for two sets of 20 repetitions for the resident's lower extremities, ambulation to the dining room with a three-wheeled walker and application of the TENS unit to the resident's back for one hour on level 6 setting. However, review of the Care Plan for Resident #96 revealed that it had not been revised to include the Restorative Nursing Program services for restorative active range of motion exercises, ambulation and the application of the TENS unit. During an interview on 07/26/2012 at 1:20 p.m., the Assistant Director of Nursing (ADON) acknowledged that the resident's Care Plan did not include the provision of Restorative Nursing Program services. Review of the resident's June and July, 2012 Restorative Care Flow Records revealed no evidence that the resident was provided restorative active range of motion exercises to the right lower extremity, and ambulation to the dining room with the walker from 6/01 to 6/11/12, on 6/16/12, 6/18/12, 6/20/12; 6/21/12, 6/24/12, 6/25/12, 7/01 to 7/04/12, on 7/07/12, 7/08/12, 7/10/12, 7/11/12, 7/14/12, 7/15/12, 7/22/12, and 7/23/12. There was no evidence that staff had applied the TENS unit on 6/02/12, 6/03/12, for 6/05 to 6/11/12, on 6/15/12, 6/18/12, 6/20/12, 6/21/12, from 6/23 to 6/25/12, from 7/02 to 7/04/12, on 7/07/12, 7/08/12, 7/11/12, and 7/24/12. During an interview on 7/26/12… | 2017-06-01 |
| 7245 | 7245 | EARLY MEMORIAL NURSING HOME | 115271 | 11740 COLUMBIA ROAD | BLAKELY | GA | 39823 | 2012-07-26 | 323 | D | 0 | 1 | 01VM11 | Based on an observation, review of the work order book and staff interview, it was determined that the facility failed to maintain a level floor in one of four shower stalls in one of two common shower rooms (wing 2). Findings include: At noon on 7/23/12 during the initial tour, it was observed that the Common Shower room on wing 2 had four shower stalls. One of the shower stalls had an approximately three by five inch area of missing floor tiles which exposed the concrete floor underneath it. The exposed concrete floor had been eroded to an approximately three inch depth indention. That indention in the shower stall floor was in the pathway for residents being transported by staff into and out of the shower stall in a shower chair. The indention had the potential to be a hazard for the wheels on the shower chair used for residents. In an interview on 7/26/12 at 8:45 a.m., maintenance staff stated that the facility staff were supposed to complete a work order to notify maintenance staff when anything needed to be repaired. He said that there was a work order form kept in a book at each nurse's station. However, a review of the work order book revealed no evidence that staff had completed a work order form to notify the maintenance staff about the hole in the shower floor. During interviews on 7/26/12 between 8:45 a.m. and 9:00 a.m., wing 2 CNAs SS and QQ and housekeeping staff RR said that they were aware of the facility's system regarding the use of work orders but, they had not used that process to report the hole in the shower stall's floor. After surveyor inquiry, the hole in the floor was immediately repaired. | 2017-06-01 |
| 8335 | 8335 | COOK SENIOR LIVING CENTER | 115655 | 706 NORTH PARRISH AVE . | ADEL | GA | 31620 | 2012-02-23 | 156 | B | 0 | 1 | 028H11 | Based on record review and staff interview, it was determined that the facility had failed to provide three (#33, #100, and #51) of three sampled residents, who were discharged from Medicare Part A services, with the CMS- form and the Skilled Nursing Advanced Beneficiary Notice (SNFABN) form (CMS - ) or a mandatory uniform Denial Letter to inform the resident of his/her right to an appeal and potential liability for the non-covered services and the estimated cost of those non-covered services. Findings include: On 2/23/12 at 1:12 p.m., the Minimum Data Set (MDS) coordinator stated that she had not provided the CMS- form and the SNFABN form or a mandatory uniform Denial Letter to residents who had been discontinued from Medicare Part A services for coverage reasons. She had incorrectly provided the CMS-R-131, a Medicare Part B form. Twenty-three residents had been discharged from Medicare Part A services for coverage reasons since 9/27/11. 1. Resident #33 was notified by the facility on 1/26/12 that Medicare Part A coverage for skilled services would end on 1/30/12. However, the facility failed to provide the resident with the required CMS form and the CMS- form or a uniform Denial Letter to inform the resident of his/her right to an appeal and potential liability for the non-covered services and the estimated cost of those non-covered services if the resident chose to continue to receive them. 2. Resident #100 was notified by the facility on 10/7/11 that Medicare Part A coverage for skilled services would end on 10/10/11. However, the facility failed to provide the resident with the required CMS form and the SNFABN form or uniform Denial Letter to inform the resident of his/her right to an appeal and potential liability for the non-covered services and the estimated cost of those non-covered services if the resident chose to continue to receive them. 3. Resident #51 was notified by the facility on 11/28/11 that Medicare Part A coverage for skilled services would end on 12/1/11. However, the facility failed to pro… | 2016-03-01 |
| 8336 | 8336 | COOK SENIOR LIVING CENTER | 115655 | 706 NORTH PARRISH AVE . | ADEL | GA | 31620 | 2012-02-23 | 241 | E | 0 | 1 | 028H11 | Based on observations, it was determined that the facility failed to provide a dignified dining experience during two of two meals observed in the South hall dining room. Findings include: Observations during the lunch meals on 2/20/12 and 2/22/12 in the South hall dining room revealed that residents sat and watched other residents eat before being served and/or assisted to eat their meals. 1. On 2/20/12, nursing staff were observed serving residents' lunch trays in the South Hall dining room from 11:30 a.m. to 11:50 a.m. At 11:50 a.m., there were 31 residents and 5 nursing staff members in the dining room. All five staff members were seated and assisting residents to eat but, not all of the residents had been served their meal. Seven residents had not been served. Those seven residents were not served and assisted to eat until 12:15 p.m. 2. One resident was observed with his/her lunch plate set up in front of him/her but, his/her silverware was not wrapped from 11:30 a.m. to 12:05 p.m. The resident began eating at 12:05 p.m after staff unwrapped the silverware. 3. One resident was observed playing with his/her food and untensils from 11:30 a.m. to 12:05 p.m. A staff member finished assisting another resident at 12:05 p.m. and then sat down to assist the resident. 4. On 2/22/12 at 11:20 p.m., staff failed to serve lunch at the same time to a table of five residents. During the observation, the first resident was served at 11:25 a.m. and the last resident at the table was not served until 12:02 p.m. 5. On 2/22/12 between 11:20 a.m. and 12:05 p.m., there were seven residents sitting at one table. The first resident at that table was served at 11:25 a.m. but, the last resident was not served his/her meal tray until 30 minutes later at 11:55 a.m Another table had five residents seated at it. The first resident was served at 11:30 a.m. but, the last resident was not served until 30 minutes later at 12:00 noon. Across the back of the dining room were five residents seated in a line. Staff served the first resident at 1… | 2016-03-01 |
| 8337 | 8337 | COOK SENIOR LIVING CENTER | 115655 | 706 NORTH PARRISH AVE . | ADEL | GA | 31620 | 2012-02-23 | 253 | E | 0 | 1 | 028H11 | Based on observations, it was determined that the facility failed to maintain an environment that was free from dirty floors, rusty metal frames on raised toilet seats, a broken toilet paper holder, a rusty free standing toilet paper holder, a soiled commode chair seat, worn finishes on nightstands, a broken nightstand door, cracked and bubbled wallpaper, stored unused equipment in a common shower room, peeling trim on overbed tables, peeling wood and, soiled urinals on one (North hall) of four halls. Findings include: Observations were made during the initial tour on 2/20/12 between 11:10 a.m. and 11:40 a.m. and, during the environmental tour on 2/23/12 between 1:15 p.m. and 2:00 p.m 1. The bathroom floor around the door frame had a heavy build up of a black substance in room 344. The nightstand door was broken at the A bed location. 2. There was a rusty metal frame on the raised toilet seat in the bathroom of room 346. The toilet paper holder was broken. The seat of the commode chair was soiled. The floor had a heavy build up of dust and debris. 3. There was a rusty metal frame on the raised toilet seat in the bathroom of room 350. The wood was peeling off of the bathroom door. 4. The finish was worn off of the nightstands for A and B beds in room 354. There was a rusty free standing toilet paper holder in the bathroom. 5. The wallpaper was cracked and bubbled on the wall next to the window in room 341. 6. The edging was peeling off of the overbed table in room 345A. 7. There was a urinal on the siderail that had a dried white substance along the inside of it in room 352C. 8. There was a urinal on the overbed table that had a black substance along the lid in room 356C. 9. There were three mechanical lifts, two reclining chairs, two overbed tables, two geri chair table tops, a tube feeding pole, a tube feeding pump, two vital sign machines, a mattress overlay, a blood pressure machine, five straight chairs and one wheelchair stored in the common shower room. | 2016-03-01 |
| 8338 | 8338 | COOK SENIOR LIVING CENTER | 115655 | 706 NORTH PARRISH AVE . | ADEL | GA | 31620 | 2012-02-23 | 282 | D | 0 | 1 | 028H11 | Based on observation, record review and staff interview, it was determined that the facility failed to provide nail care for one (#106) of 32 sampled residents. Findings include: Resident #106 was coded by licensed staff on the 1/14/12 quarterly Minimum Data Set (MDS) assessment as requiring limited assistance with personal hygiene. The resident had a plan of care since 10/12/11 to address his/her self care deficit. There was an intervention for staff to provide nail care weekly and as needed. However, the resident was observed to have brown matter underneath his/her fingernails on both hands on 2/21/12 at 10:15 a.m., on 2/22/12 at 11:00 a.m. after receiving a shower, and on 2/23/12 at 10:15 a.m See F312 for additional information regarding resident #106. | 2016-03-01 |
| 8339 | 8339 | COOK SENIOR LIVING CENTER | 115655 | 706 NORTH PARRISH AVE . | ADEL | GA | 31620 | 2012-02-23 | 309 | D | 0 | 1 | 028H11 | **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 for two residents (#86 and #104) from a total sample of 32 residents. Findings include: 1. Resident #86 had a physician's orders [REDACTED]. However, a review of the October 2011 Medication Administration Record [REDACTED]. A review of the December 2011 MAR indicated [REDACTED]. Licensed nursing staff documented on that MAR indicated [REDACTED]. However, there was no evidence of when the medication was obtained or that the dose was administered. 2. Resident #104 had a physician's orders [REDACTED]. However, a review of nursing staff's documentation on the resident's MAR indicated [REDACTED]. During an interview on 2/22/12 at 4:30 p.m., the Director of Nursing (DON) stated that the restart and administration of the medication on 2/10/12 was an error on the nurses part. On 2/23/12 at 11:30 a.m., the resident's physician stated that the facility had called him after surveyor inquiry. He stated that he had written an order for [REDACTED].> | 2016-03-01 |
| 8340 | 8340 | COOK SENIOR LIVING CENTER | 115655 | 706 NORTH PARRISH AVE . | ADEL | GA | 31620 | 2012-02-23 | 312 | D | 0 | 1 | 028H11 | Based on observation, record review and staff interview, it was determined that the facility failed to provide nail care for one (#106) of 32 sampled residents. Findings include: Resident #106 was coded by licensed staff on the 1/14/12 quarterly Minimum Data Set (MDS) assessment as requiring limited assistance with personal hygiene. The resident had a plan of care since 10/12/.11 to address his/her self care deficit related to his/her generalized weakness. There was an intervention for staff to provide nail care weekly and as needed. However, the resident was observed to have brown matter underneath his/her fingernails on both hands on 2/21/12 at 10:15 a.m., on 2/22/12 at 11:00 a.m. after being given a shower by nursing staff and, on 2/23/12 at 10:15 a.m During an interview on 2/23/12 at 10:50 a.m., certified nursing assistant (CNA) BB stated that staff would clean under a resident's fingernails if they noticed they were dirty. | 2016-03-01 |
| 8341 | 8341 | COOK SENIOR LIVING CENTER | 115655 | 706 NORTH PARRISH AVE . | ADEL | GA | 31620 | 2012-02-23 | 314 | D | 0 | 1 | 028H11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and record review, it was determined that the facility failed to ensure interventions were in place to prevent pressure ulcer development for one resident (#72 ) who had a history of [REDACTED]. Findings include: Resident #72 had an annual Minimum Data Set (MDS) assessment completed on 12/2/11. Licensed staff coded him/her as requiring extensive assistance with bed mobility, personal hygiene, bathing, and dressing and total assistance with transfers and toilet use. The resident was coded as being at risk for pressure ulcer development. In section M1200 of the MDS assessment, licensed staff had checked that a pressure reducing device for the bed was in use. Nursing staff developed a care plan dated 2/25/11 to address the resident's risk for skin integrity impaired because of having had a pressure ulcer on admission, impaired mobility, bowel and bladder incontinence and decreased nutritional status. During observation on 2/20/12 at 3:15 p.m., the resident was in bed sleeping. The alternating pressure pump attached to the foot board of the bed was in the 'off' position so that the overlay pressure pad was not inflated. It was observed on 2/21/12 at 8:10 a.m., 9:00 a.m., 1:30 p.m., 3:00 p.m., 4:10 p.m. and 5:10 p.m. and on 2/22/12 at 7:05 a.m., 8:20 a.m. and 8:55 a.m., that the resident was in the bed with the alternating pressure pump in the 'off' position and the overlay pressure pad not inflated. | 2016-03-01 |
| 8342 | 8342 | COOK SENIOR LIVING CENTER | 115655 | 706 NORTH PARRISH AVE . | ADEL | GA | 31620 | 2012-02-23 | 328 | E | 0 | 1 | 028H11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interviews with a resident and staff, it was determined that the facility failed to properly store respiratory therapy equipment for four sampled residents (#32, #73, #90 and A) and for two unsampled residents from a total sample of 32 residents. Findings include: Review of the facility's Policy and Procedure for Respiratory Therapy Equipment revealed that oxygen cannulas and tubing were to be stored in a plastic bag when not in use. Nebulizers were to be stored in a plastic bag. Staff were to change the prefilled humidifier bottles when the water level was low. However, staff failed to implement those procedures for residents #32, #73, #90, A and two unsampled residents. 1. Resident #32's nebulizer mouthpiece and tubing were uncovered and laying on the floor on 2/20/12 at 3:05 p.m. and on 2/21/12 at 8:30 a.m. 2. The oxygen mask and tubing for resident #73 was uncovered and draped over the oxygen meter on the wall on 2/20/12 at 3:00 p.m. On 2/21/12 at 8:35 a.m., the mask and tubing was in a plastic bag dated 6/12/11. 3. The nebulizer mouthpiece and tubing for resident #90 was uncovered, draped over the oxygen meter and was not dated on 2/20/12 at 2:30 p.m. and on 2/21/12 at 8:35 a.m. 4. Resident A had a 9/29/11 physician's orders [REDACTED]. However, the resident's oxygen was set at 3Liters/minute and the humidifier bottle was empty on 2/20/12 at 2:30 p.m., 2/21/12 at 9:00 a.m., and 4:00 p.m., 2/22/12 at 8:35 a.m. and 4:45 p.m. and on 2/23/12 at 10:00 a.m. There was also an uncovered oxygen mask draped over the oxygen meter on those dates and times. During an interview on 2/23/12 at 10:00 a.m., resident A stated that the inside of his/her nose would get dry, sore and would bleed at times. The following observations were made during the initial tour on 2/20/12 between 11:10 a.m. and 11:40 a.m 5. The oxygen tubing was draped over the oxygen meter and was not dated in room [ROOM NUMBER]A. 6. The oxygen mas… | 2016-03-01 |
| 8343 | 8343 | COOK SENIOR LIVING CENTER | 115655 | 706 NORTH PARRISH AVE . | ADEL | GA | 31620 | 2012-02-23 | 371 | F | 0 | 1 | 028H11 | Based on observations and staff interview, it was determined that the facility failed to maintain the floor pantry ice machine on the North Hall in a clean and sanitary condition. Findings include: During the environmental tour on 2/23/12 at 1:13 p.m., the ice machine in the floor pantry on the North hall had a heavy build up of a brown substance in the back of the machine where the ice was made. During an interview on 2/23/12 at 3:05 p.m., the administrator stated that the floor tech was supposed to be cleaning the machine. After surveyor inquiry, he/she provided a cleaning schedule to be instituted 2/24/12. | 2016-03-01 |
| 8344 | 8344 | COOK SENIOR LIVING CENTER | 115655 | 706 NORTH PARRISH AVE . | ADEL | GA | 31620 | 2012-02-23 | 428 | D | 0 | 1 | 028H11 | Based on record review and staff interview, it was determined that the facility failed to act upon a pharmacy recommendation for one resident (#86) from a total sample of 32 residents. Findings include: Resident #86 had a recommendation from the pharmacist on 9/30/11 for the physician to review the continued need for the medication Procrit due to the medication being held several times for hemaglobin levels greater than 12. The resident's attending physician's documented response on the recommendation form was that another physician had ordered the medication. There was no further evidence in the clinical record that the pharmacist's recommedation was addressed. The Director of Nursing confirmed on 2/23/12 at 4:40 p.m. that the recommendation was not addressed. | 2016-03-01 |
| 8345 | 8345 | COOK SENIOR LIVING CENTER | 115655 | 706 NORTH PARRISH AVE . | ADEL | GA | 31620 | 2012-02-23 | 431 | D | 0 | 1 | 028H11 | Based on observation, record review and staff interview, it was determined that the facility failed to properly store controlled medications in a separately locked compartment on one (North) of two halls. Findings include: Review of the facility's Policy and Procedure for Controlled Medications revealed that controlled drugs were to be placed in the locked controlled drug cabinet in the medication rooms. However, nursing staff failed to secure a controlled drug in the North Hall medication room. During an observation of the North Hall medication storage room on 2/23/12 at 12:00 p.m., there was a bubble pack of 30 tablets of Vicodin 5/500 milligrams in an unlocked cabinet. There was a sheet of paper wrapped around the pack with the resident's name, a date of 2/22/12 and a note on it that 30 tablets remained. Licensed nurse AA stated at that time that the medication should not have been stored in an unlocked cabinet. The nurse immediately placed the medication in a separate locked box that was affixed to the wall. AA stated that when a controlled substance had been discontinued, the medication and the count sheet was supposed to be taken to the nursing supervisor. | 2016-03-01 |
| 2182 | 2182 | RENAISSANCE CENTER FOR NURSING AND HEALING | 115537 | 415 AIRPORT ROAD | GRIFFIN | GA | 30223 | 2016-12-08 | 278 | D | 0 | 1 | 02KJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to accurately assess the use of anticoagulants during the seven (7) day look back period for Resident (R) #174's Minimum Data Set (MDS) Initial Assessment. The sample was 27. Findings include: R #174 admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review ofthe physician orders [REDACTED]. Review of admission medical records shows no anticoagulants have been given to R #174 from the time of admission. Review of MDS admission assessment dated [DATE] section N for medication shows R #174 had a seven (7) day look back for anticoagulants; However, record revealed that the resident was not admitted on any anticoagulant medications. Interview on 12/08/2016 at 1:45:40 p.m. with staff HH revealed that R #174 was not admitted on any anticoagulant medication. Staff HH stated that she mistakenly classified resident's aspirin as an anticoagulant. | 2020-09-01 |
| 2183 | 2183 | RENAISSANCE CENTER FOR NURSING AND HEALING | 115537 | 415 AIRPORT ROAD | GRIFFIN | GA | 30223 | 2016-12-08 | 279 | D | 0 | 1 | 02KJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview it was determined the facility failed to ensure a care plan was developed for an anticoagulant medication for one resident, #94, from a sample of 27 residents. Findings include: Resident (R) #94 medical record documented the following Diagnosis: [REDACTED]. Review of the medical record physician orders, for 11/25/16 the physician ordered [MEDICATION NAME] sodium ([MEDICATION NAME]) solution 5000 unit/mL, inject 5000 unit subcutaneously every 12 hours for clotting prevention. Review of the medical record revealed no care plan for the resident ' s anticoagulant, [MEDICATION NAME]. Interview on 12/7/16 at 4:15 p. m. with HH, Minimum Data Set (MDS) Coordinator revealed she confirmed a care plan was not developed for the resident's anticoagulant and a care plan should have been written. Continued interview with HH revealed the unit manager is responsible for developing the care plan for any new medications once the resident is readmitted to the facility from the hospital. Interview on 12/7/16 at 4:30 p. m. with BB. Licensed Practical Nurse (LPN) unit manager revealed resident #94 was readmitted to the facility from the hospital on [DATE] with a new order for the anticoagulant, [MEDICATION NAME]. Continued interview with BB revealed she cannot recall if she assisted with the resident 's re-admission to the facility. The LPN confirmed when a resident returns to the facility from a hospitalization the unit manager is to review the residents discharge orders from the hospital and if a new medication such as an anticoagulant is ordered a care plan should be developed. The LPN revealed there is no care plan for the resident ' s anticoagulant then, it was not done. Review of the care plan policy revealed the care plan must be customized to each individual patient ' s needs. If there is not a care plan available to meet a patient ' s needs, center staff may develop one using the custom care plan in point … | 2020-09-01 |
| 2184 | 2184 | RENAISSANCE CENTER FOR NURSING AND HEALING | 115537 | 415 AIRPORT ROAD | GRIFFIN | GA | 30223 | 2016-12-08 | 323 | D | 0 | 1 | 02KJ11 | Based on observation and interview the facility failed to provide a safe environment for one (1) Resident by allowing a power strip to be used to power an oxygen concentrator that was in use and allowing the power strip to lay in the floor causing a trip hazard. Sample size was twenty-seven (27). Findings include: Observation of a power strip laying on floor with oxygen concentrator plugged into it with oxygen in use noted on initial tour on 12/5/16 at 3:41 p.m. Observation of power strip laying in floor next to bed with oxygen concentrator plugged into in with oxygen in use on 12/8/16 at 10:28 a.m. In an interview with the maintenance director on 12/8/16 at 10:32 a.m. he confirmed that the power strip was being used unsafely having the oxygen concentrator plugged into it and it laying on the floor. Said he was unaware of the power strip being used at all and he is aware that this is unacceptable and would correct the problem immediately. Observation on 12/8/16 at 5:57 p.m revealed resident sitting on bed oxygen in use, power strip mounted to bed side table with only computer and phone charger plugged into it and the oxygen concentrator plugged into wall socket. | 2020-09-01 |
| 2185 | 2185 | RENAISSANCE CENTER FOR NURSING AND HEALING | 115537 | 415 AIRPORT ROAD | GRIFFIN | GA | 30223 | 2016-12-08 | 328 | E | 0 | 1 | 02KJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview and review of facility policy, NSG230 Respiratory Equipment/Supply Cleaning/Disinfection, the facility failed to clean the filter on the oxygen (O2) concentrators for nine (9) residents (R) R#6, R#14, R#25, R#71, R#76, R#93, R#155, R#156 and R#160 of twenty-two (22) sample residents. Findings Include: Resident (R#6) was admitted to the facility with a primary [DIAGNOSES REDACTED]. Observation of R#6 on 12/6/16 at 4:41 p.m. and on 12/7/16 at 9:05 a.m. revealed resident in bed wearing a nasal cannula attached to an O2 concentrator set at three (3) liters per minute (lpm) with humidity. The filter on the O2 concentrator was covered in dust. Observation of the O2 concentrators on 12/6/16 from 4:44 p.m. until 5:20 p.m. in the rooms of R#14, R#25, R#71, R#76, R#93, R#155, R#156 and R#160 revealed the filters were covered in dust. During an observation and interview with the Director of Nursing (DON) on 12/7/16 at 9:10 a.m. she confirmed the O2 concentrator filter for R#6 was covered in dust. She removed the filter, cleaned the filter, dried the filter and replaced the filter. She stated her expectation is for the staff to clean the filters weekly when changing the tubing. During an additional observation and interview with the DON on 12/7/16 from 9:14 a.m. until 9:36 a.m. she confirmed the O2 concentrator filters for R#14, R#25, R#71, R#76, R#93, R#155, R#156 and R#160 were covered in dust. Review of the facility policy titled NSG230 Respiratory Equipment/Supply Cleaning/Disinfection with a review date of 3/1/16 indicated cleaning and disinfection is performed by a respiratory therapist, licensed nurse, or equipment technician. All respiratory equipment which cannot be immersed in water is cleaned with a disinfecting solution and allowed to dry. Disinfection is performed on all equipment on a scheduled basis and upon discontinuation from service and between patients. Respiratory equipment requiring disinfection… | 2020-09-01 |
| 2186 | 2186 | RENAISSANCE CENTER FOR NURSING AND HEALING | 115537 | 415 AIRPORT ROAD | GRIFFIN | GA | 30223 | 2016-12-08 | 371 | E | 0 | 1 | 02KJ11 | Based on observation, staff interview, and record review it was determined the facility failed to ensure a refrigerator in one resident room was clean, temperature recorded, and outdated food items discarded; failed to ensure opened food items in the kitchen refrigerators, freezers, and dry storage were securely wrapped, labeled, and dated; failed to ensure the meat slicer, stand-up mixer, walk-in freezer floor, reach in freezer door were clean and free from debris; failed to discard cottage cheese, peeled garlic, and chocolate milk by the best by date. This deficient practice had the potential to effect 136 residents receiving an oral diet. Findings include: Observation on 12/5/16 at 10:33 a. m. of the reach-in refrigerator revealed a one gallon container of peeled fresh garlic with a use by date of (MONTH) 24, (YEAR). Observation on 12/5/16 at 10:45 a. m. of the dry storage area revealed an open ten pound bag of elbow macaroni which was not securely wrapped. Observation on 12/5/16 at 10:50 a. m. of the walk-in refrigerator revealed two, five pound containers of cottage cheese with a use by date of 12/2/16. Continued observation of the walk-in refrigerator revealed a round white plastic container cover with plastic wrap with a label stating beef soup, made date 11/27/16 and discard date 12/3/16. Further observation revealed a block of cheddar cheese four inches in length and one inch in height in clear plastic resealable bag that was not sealed and exposed to the air. Observation on 12/5/16 at 11:10 a. m. of the meat slicer revealed the bottom area where the slicing arm is connected to the slicer had a black substance with food debris. This black substance and food debris was collected in a small tray that was 18 inches in length and two inches in width. Observation on 12/5/16 at 11:15 a. m. of the stand-up mixer revealed a white substance under the mixing arm which was one inch in length and quarter inch in width. Continued observation revealed when the white substance was touched it flaked off. Observation on … | 2020-09-01 |
| 2187 | 2187 | RENAISSANCE CENTER FOR NURSING AND HEALING | 115537 | 415 AIRPORT ROAD | GRIFFIN | GA | 30223 | 2016-12-08 | 406 | D | 0 | 1 | 02KJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to follow a consultant physician ' s recommendations for a lumbar brace for one (1) resident (R#55) out of twenty-seven (27) sampled residents. Findings include: During an interview on 12/6/16 at 9:05 a.m., R#55 informed surveyor that she had not received a back brace which was supposed to be ordered several weeks ago. She stated that she was told the order was given to therapy and was then told by therapy that the order was given back to nursing. R#55 reported that her pain has been somewhat better since she has been receiving the [MEDICATION NAME] as ordered. Review of the Minimum Data Set (MDS) Admission assessment dated [DATE] revealed resident with Brief Interview of Mental Status (BIMS) score of fifteen (15)and active [DIAGNOSES REDACTED]. Report of Consultation dated 11/14/16 documented R#55 to have L4 compression fractures noted on an (MONTH) MRI and patient unable to sit up due to pain. Recommendations were for a lumbar brace, nasal calcitonin, and [MEDICATION NAME] with follow up in 4-6 weeks. During observation of medication administration on 12/7/16 at 10:30 a.m., R#55 questioned the nurse regarding the status of the back brace that was ordered by the orthopedic. Licensed Practical Nurse (LPN) AA responded that she did notify therapy but would follow up. Interview with LPN AA on 12/08/2016 at 1:25 p.m. revealed that she made a copy of the recommendation for a lumbar brace for R#55 and took the order to the therapy department. Interview with the Rehabilitation Director (RD) on 12/08/2016 at 1:00 p.m. revealed that residents are not measured for back braces and only receive back braces when they bring the brace with them upon admission to the facility. RD informed that if a resident goes out of the facility to see a specialist, that specialist is responsible for ordering the back brace. Interview with LPN Unit Manager BB on 12/08/2016 at 1:53 p.m. revealed that … | 2020-09-01 |
| 2188 | 2188 | RENAISSANCE CENTER FOR NURSING AND HEALING | 115537 | 415 AIRPORT ROAD | GRIFFIN | GA | 30223 | 2016-12-08 | 514 | D | 0 | 1 | 02KJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interviews and review of facility policy, NSG253 [MEDICAL TREATMENT] Communication and Documentation the facility failed to maintain complete [MEDICAL TREATMENT] communication forms for one (1) resident (R#107) of twenty-seven (27) sample residents. Findings Include: Resident (R#107) was admitted to the facility on [DATE] with a primary [DIAGNOSES REDACTED]. Record review of the [MEDICAL TREATMENT] Communication Record forms for the months of October, and (MONTH) (YEAR) revealed missing forms for 10/1/16, 10/4/16, 10/13/16, 11/1/16, 11/17/16 and 11/22/16. Review of the facility policy titled NSG253 [MEDICAL TREATMENT] Communication and Documentation dated 5/1/16 indicated center staff will communicate with the [MEDICAL TREATMENT] center prior to sending a patient for [MEDICAL TREATMENT] by completing the [MEDICAL TREATMENT] Communication Record or other state required form and sending it with the patient. The form will also be completed upon return of the patient from the [MEDICAL TREATMENT] center. The policy also indicated upon return of the patient to the Center, a licensed nurse will review the [MEDICAL TREATMENT] center communication; evaluate/observe the patient; document the evaluation/observation on the [MEDICAL TREATMENT] Communication Record or state required form, notify the [MEDICAL TREATMENT] center if the form is not returned with the patient and ask that it be faxed to the center; document notification of [MEDICAL TREATMENT] center regarding return of form or other communication; maintain the [MEDICAL TREATMENT] Communication Record or state required form in the patient's medical record. During an interview with the Director of Nursing (DON) on 12/8/16 at 5:00p.m. she stated she expects the nursing staff to document in the nurses notes all [MEDICAL TREATMENT] communication information received on the [MEDICAL TREATMENT] Communication Record form or if no change in condition/other pertinent informat… | 2020-09-01 |
| 3400 | 3400 | LIFE CARE CTR OF LAWRENCEVILLE | 115659 | 210 COLLINS INDUSTRIAL WAY | LAWRENCEVILLE | GA | 30045 | 2016-11-04 | 164 | D | 0 | 1 | 03D011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, admission record review, scheduler job description review, employee file review, facility policy review, and staff interview, the facility failed to maintain confidentiality for one resident (R) (R217) when protected health information from, the clinical record of R217 was given to another residents (R250) family member. The sample size was 34 residents. Findings include: Per clinical record review, R217 was admitted to the facility on [DATE]. The admission Minimum Data Set (MDS) assessment, Section C, dated 6/2/16, identified that the resident had a Brief Interview for Mental Status (BIMS) score of 15. The resident was cognitively aware and able to make her own decisions. On 5/29/16, R217 signed admission paperwork, titled INFORMED DECISION REGARDING NURSING HOME PLACEMENT that granted the facility permission to release her clinical records under the following circumstances, .The Resident/Representative authorizes the release of complete and accurate Resident information, in sufficient detail to provide for continuity of care, from any facility or institution transferring Resident to the Facility, or to another health care provider to which the Resident is transferring .The Resident/Representative understands and agrees that the Medical Record concerning the Resident is and will continue to be the property of the Facility, provided that the Facility will not disclose same to any person or party other than the Resident and agencies authorized by law without either the consent of the Resident or appropriate order . A document titled, PRIVACY/SECURITY EVENT REPORTING FORM identified that the Medical Records Director (MRD) was notified on 7/26/16 that a breach in confidentiality occurred. A letter was sent to R217 on 8/11/16. The following was written, .I am writing to you with important information about a recent breach of your personal information .We became aware of this breach on (MONTH) 26, (YEAR). A former … | 2020-09-01 |
| 3401 | 3401 | LIFE CARE CTR OF LAWRENCEVILLE | 115659 | 210 COLLINS INDUSTRIAL WAY | LAWRENCEVILLE | GA | 30045 | 2016-11-04 | 280 | D | 0 | 1 | 03D011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, clinical record review, and review of the Resident Assessment Instrument Manual, the facility failed to ensure a care plan for one resident (R) (R165) was updated when an antipsychotic medication was discontinued, which had the potential of the resident to receive an antipsychotic without clinical justification. In addition, the care plan for R165 also failed to include non-pharmacological interventions to address behaviors. The sample size was 34 residents. Findings include: Per clinical record review, R165 was re-admitted to the facility on [DATE] with a [DIAGNOSES REDACTED]. The electronic medical record contained a behavioral care plan which was dated, as initiated, on 11/4/14. The care plan identified R165 as being physically and verbally abusive, socially inappropriate, wandering and resisting care related to her [DIAGNOSES REDACTED]. The goals of this care plan identified the resident as being at risk for side effects from the use of an antipsychotic medication. There was no mention of non-pharmacological interventions to address the residents ' behavior on either care plan. A quarterly Minimum Data Set (MDS) assessment, dated 5/14/16, identified the resident as being moderately impaired cognitively, having no [MEDICAL CONDITION] or delusions, and having no behaviors that would have harmed others or herself. Refer to F329 for detailed information. In (MONTH) (YEAR), the pharmacist asked the physician for a trial to discontinue administration of [MEDICATION NAME] (antipsychotic medication). On 7/19/16, the physician discontinued administration of the [MEDICATION NAME]. Refer to F329 for detailed information. On 8/9/16, the [MEDICATION NAME] was restarted by the Physician Assistant who ordered [MEDICATION NAME] 0.25 mg to be administered daily, at 2:00 p.m. each day. An observation was conducted of the resident during the survey 11/2/16 at 5:51 a.m. She was observed sleeping in her wheelchair in a c… | 2020-09-01 |
| 3402 | 3402 | LIFE CARE CTR OF LAWRENCEVILLE | 115659 | 210 COLLINS INDUSTRIAL WAY | LAWRENCEVILLE | GA | 30045 | 2016-11-04 | 328 | E | 0 | 1 | 03D011 | Based on observation and staff interview, the facility failed to ensure oxygenators (oxygen machines) had clean air filters for four of eight residents (R5, R153, R343, R345) who used the oxygen machines on the 100 hall Findings include: An observation on 10/31/16 at 9:28 a.m. in the room for R5 revealed the oxygenator had an air filter observed to have a build-up of dirt and debris on the filter. In the same room, the oxygenator for R153 also had an air filter with built-up dirt and debris on it. An observation of the oxygenator filter for the oxygen machine for R343 on 10/31/16 at 9:38 p.m. revealed the filter had a build-up dirt and debris. An observation of the oxygenator filter for the oxygen machine for R345 on 10/31/16 at 9:51 a.m. revealed the oxygenator filter had so much dirt and debris on it, the color of the filter had changed from black to cream-colored and when the filter was removed, by maintenance, debris was observed to fall off of the filter. An interview with registered nurse (RN) AA, on 10/31/16 at 9:38 a.m., revealed maintenance was responsible for checking and cleaning the air filters on oxygenators on a quarterly basis. She demonstrated she did not know how to remove an air filter for inspection. An interview with the Maintenance Director on 10/31/16 at 9:43 a.m. confirmed the air filters for R5, R153, R343 and R345 were dirty, had debris on them and needed to be cleaned or replaced. He also stated maintenance was responsible for replacing air filters on a quarterly basis. He further stated that the air filters for R5, R135 and R343 had not been inspected, cleaned or replaced since (MONTH) of (YEAR) by maintenance. He further stated that he could find no evidence of the air filter for the oxygenator for R345 had ever been inspected, replaced or cleaned. An interview with the Director of Nursing on 11/3/16 at 3:00 p.m. revealed maintenance was responsible for replacing, cleaning and inspecting air filters for oxygenators on a quarterly basis, but nurses were also to inspect the filters on a … | 2020-09-01 |
| 3403 | 3403 | LIFE CARE CTR OF LAWRENCEVILLE | 115659 | 210 COLLINS INDUSTRIAL WAY | LAWRENCEVILLE | GA | 30045 | 2016-11-04 | 329 | D | 0 | 1 | 03D011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, clinical record review and antipsychotic medication policy review, the facility failed to ensure two of five residents (R) (R337 and R165) who were reviewed for unnecessary medication use, were not prescribed unnecessary medications. Specifically, the facility failed to: monitor behaviors to justify antipsychotic medication initiation, following a period of discontinued antipsychotic medication use, for R165 and the facility failed to ensure justification for, and monitor the efficacy, of an as needed (PRN) muscle relaxant medication for R337. Findings include: 1. Per clinical record review, R165 was re-admitted to the facility on [DATE] with a [DIAGNOSES REDACTED]. A Psychoactive Medication Informed Consent dated 11/4/14, was identified in the medical record. The electronic medical record contained a Behavioral Care Plan which was dated, as initiated, on 11/4/14. The care plan identified that R165 was physically and verbally abusive, socially inappropriate, wandered and resisted care. It was documented that these problems were related to her [DIAGNOSES REDACTED]. A quarterly Minimum Data Set (MDS) assessment dated [DATE], Section C for Cognition, documented that the resident had a Brief Interview for Mental Status (BIMS) score of 9, which identified the resident as moderately impaired cognitively. Section E, for Behavior documented that the resident had no [MEDICAL CONDITION] or delusions during this assessment period. Under this same section, it was noted that the resident did not wander and did not have behaviors that would have harmed others or herself. A pharmacist Consultation Report dated 7/1/16 through 7/31/16, identified that R165 received [MEDICATION NAME] 0.25 milligrams (mg) which was administered at bedtime since (MONTH) (YEAR). The pharmacist asked the physician to consider a trial discontinuance of the [MEDICATION NAME] or document a clinical indication to the dosage. The physician discont… | 2020-09-01 |
| 3404 | 3404 | LIFE CARE CTR OF LAWRENCEVILLE | 115659 | 210 COLLINS INDUSTRIAL WAY | LAWRENCEVILLE | GA | 30045 | 2016-11-04 | 431 | D | 0 | 1 | 03D011 | Based on observations, review of medication storage policies, and staff interviews, the facility failed to label an opened vial of insulin in one of six medications carts and failed to properly store suppositories in one of three medication refrigerators. Findings include: 1. During an observation of a medication cart, on the 400 hall, on 11/3/16 at 1:13 p.m., a partially used vial of Lantus (insulin) was observed in a drawer. The partially used vial of Lantus was observed not to have a label attached to it describing to whom the medication was prescribed, route of administration, instructions or precautions for its use, or when it was opened. A review of the facility's policy and procedures entitled Injectable Medications in the section entitled Storage Recommendations indicated insulin vials should be dated when opened and discarded 28 days after opening. During an interview with Licensed Practical Nurse (LPN) AA who was administering medications from this medication cart, on 11/3/16 at 1:13 p.m., confirmed the partially used vial of Lantus had no label that indicated whose medication it was, when it had been opened, when it should be discarded or any instructions or precautions for its use. She stated she did not know how long the partially used vial of Lantus had been in her cart or when it was last used. She further stated the partially used vial of Lantus should not have been in her cart without an appropriate label and should have been discarded. During an interview with LPN BB, on 11/3/16 at 1:25 p.m., revealed she confirmed the partially used vial of Lantus should not have been in the medication cart for use without an appropriate label that indicated: who the medication was for, when it was opened, and with instructions for use. During an interview with the Director of Nursing (DON), on 11/3/16 at 2:05 p.m. revealed the partially opened vial of Lantus should not have been in the medication cart for use without the appropriate labeling. 2. During an observation of the medication refrigerator on the 400 h… | 2020-09-01 |
| 3405 | 3405 | LIFE CARE CTR OF LAWRENCEVILLE | 115659 | 210 COLLINS INDUSTRIAL WAY | LAWRENCEVILLE | GA | 30045 | 2016-11-04 | 441 | D | 0 | 1 | 03D011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, handwashing policy review and in-service review, the facility failed to ensure nursing staff performed hand washing in a manner that reduced the possibility of cross contamination during wound care for two of two resident treatments observed for resident (R) 318 and R334). Findings include: Observation of wound care treatment for [REDACTED]. 11:02 a.m. applied soap, did one rotary turn of hands together, rinsed five seconds under water and pulled a paper towel to dry hands. 11:05 a.m. applied soap, did two rotary turns of hands together, rinsed three seconds under water and pulled a paper towel to dry hands. 11:10 a.m. applied soap and performed a four second hand scrub time, rinsed and pulled a paper towel to dry hands. 11:14 a.m. applied soap, performed a two second scrub time, rinsed used a paper towel to dry hands. Observation of wound care treatment for [REDACTED]. 12:11 p.m. applied soap, rubbed hands together, rinsed and eight seconds after applying soap pulled a towel to dry hands. 12:23 p.m. applied soap, rubbed hands together, rinsed and eight seconds after applying soap pulled a towel to dry hands. 12:26 p.m. applied soap, performed an eight second hand scrub, rinsed and pulled a towel to dry hands 14 seconds after applying soap. 12:30 p.m. applied soap, performed a five second hand scrub, rinsed and pulled the paper towel to dry hands. 12:35 p.m. applied soap, scrubbed hands together for three seconds, rinsed for five seconds and pulled the paper towel to dry hands. In an interview on 11/3/16 at 3:50 p.m. the Director of Nursing stated staff were expected to scrub hands together (with soap) for 20 seconds and added there was no policy regarding wound care handwashing or glove changing. In an interview on 11/3/16 at 4:10 p.m. RN DD stated during a hand wash, one was to scrub for 20-25 seconds. She described the hand washing process as: apply soap, wet with water, scrub hands and back of hands … | 2020-09-01 |
| 3406 | 3406 | LIFE CARE CTR OF LAWRENCEVILLE | 115659 | 210 COLLINS INDUSTRIAL WAY | LAWRENCEVILLE | GA | 30045 | 2016-11-04 | 514 | E | 0 | 1 | 03D011 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, resident interview, medication administration policy review, and clinical record review, the facility failed to ensure medical record documentation for 5 of 34 sampled residents (R) (R14, R153, R318, R336, and R337) was accurate and complete. Specifically, medication orders, treatment orders, and/or medication administration records for R14, R153, R336, and R337 were inaccurate or incomplete also documentation related to pressure ulcers for R318 and R14 was inaccurate or incomplete. Findings include: 1. Review of clinical records for R14 indicated he was admitted to the facility on [DATE] initially for skilled rehabilitation services. R14 had [DIAGNOSES REDACTED]. A family member of R14 elected hospice services (care designed to give supportive care to people in the final phase of a terminal illness) in (MONTH) of (YEAR). Review of the undated form titled, Skin Assessment revealed R14 had seven pressure ulcers. The Skin Assessment documented the condition of the seven wounds as follows: Right hip, unstageable, measuring 2 x 5 x 1.5 with 100% slough Right Achilles, unstageable, 5 x 3, 100% eschar Right heel/lateral, unstageable, 3 x 2.5, eschar (is a slough or piece of dead tissue that is cast off from the surface of the skin) 100% Left heel, stage IV, 7.5 x 5 x .5, undermining 1 cm (centimeter) Left medial malleolus, stage III, 2 x 1 x .4 Left lateral malleolus, stage III, 1 x 1 x 4 Right lateral foot, unstageable, 3 x 9, eschar The measurements did not identify if centimeters (cm) or inches were used; the form lacked documentation of the date of completion. Two additional undated documents with descriptions of the resident's pressure ulcers (locations, descriptions, type, exudate, odor, shape, pain, peri-wound, edges, induration, granulation, slough, eschar and notes) were reviewed. It was unknown when these documents were completed; they were undated. Interview with Registered Nurse (RN) EE on 11/1/16 … | 2020-09-01 |
| 6658 | 6658 | LIFE CARE CTR OF LAWRENCEVILLE | 115659 | 210 COLLINS INDUSTRIAL WAY | LAWRENCEVILLE | GA | 30045 | 2016-11-04 | 157 | J | 1 | 0 | 03D012 | Deficiency Text Not Available | 2017-11-01 |
| 6659 | 6659 | LIFE CARE CTR OF LAWRENCEVILLE | 115659 | 210 COLLINS INDUSTRIAL WAY | LAWRENCEVILLE | GA | 30045 | 2016-11-04 | 282 | J | 1 | 0 | 03D012 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, resident and staff interview, the facility failed to follow the care plan intervention to notify the physician of changes in skin condition in a timely manner for one Resident (R) #1. In addition, the facility failed to follow the care plan related to floating heels and minimizing pressure over bony prominences for one resident (R) (#7). Ten residents were reviewed for pressure ulcers, and the sample size was 32 residents. On [DATE] a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation had caused, or had the likelihood to cause, serious injury, harm, impairment or death to residents. On [DATE] at 8:00 p.m. the facility's Divisional Vice President, Executive Director, Divisional Director of Clinical, the Director of Nursing, and the Regional Vice-President were informed of the jeopardy related to: F157:J, F281:J, F282:J, F314:J. On [DATE] at 3:43 p.m., the Executive Director was informed that Immediate Jeopardy had been identified at F223:J and F520:K in addition to F157:J, F281:J, F282:J, F314:J that were identified on [DATE]. The noncompliance related to the immediate jeopardy was identified to have existed on [DATE]. The immediate jeopardy continued through [DATE] and was removed on [DATE]. The facility implemented a Credible Allegation of Compliance related to the immediate jeopardy on [DATE]. The Immediate Jeopardy is outlined as follows: Resident #1 (R#1) was admitted to the facility on [DATE] with [MEDICAL CONDITION]/[MEDICAL CONDITION] after having a [MEDICAL CONDITIONS]. The resident was dependent on staff for Activities of Daily Living (ADL's) and was incontinent of bowel and bladder. The weekly Skin Integrity Data Collection document indicates that the resident had an open area to the sacrum on [DATE], and again on [DATE]. However, the physician was not notified of the open area and the resident did not receive any t… | 2017-11-01 |
| 6660 | 6660 | LIFE CARE CTR OF LAWRENCEVILLE | 115659 | 210 COLLINS INDUSTRIAL WAY | LAWRENCEVILLE | GA | 30045 | 2016-11-04 | 309 | D | 1 | 0 | 03D012 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, physician and staff interview, the facility failed to provide evidence that an intravenous (IV) fluid was administered and that a nephrology consult was obtained as ordered for one resident (R) (#2), and failed to provide services to prevent non-pressure related skin impairment for one resident (#3). The sample size was 32 residents. Findings include: 1. Review of the closed clinical record, for R#2, revealed that she was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Review of the physician's SOAP (Subjective-Objective-Assessment-Plan) Note with a Date of Visit of 12/5/16 documented a [DIAGNOSES REDACTED]. Review of the Addendum to this SOAP Note revealed CKD ([MEDICAL CONDITION]), IV fluids started on 12/5/16 for dehydration and asymptomatic [MEDICAL CONDITION]. na (sodium) =129 (normal sodium level is 135-145). Review of an Electronic Physician order [REDACTED]. (cubic centimeters per hour). Review of the nursing Progress Notes, for R#2, for 12/5/16 and 12/6/16 revealed that there was no mention of the resident receiving IV fluids. Review of the residents Medication Administration Records revealed that there was not any evidence of any documentation that the NS IV fluid was ever administered on 12/5/16. Interview on 2/10/17 at 4:29 p.m., with Registered Nurse (RN) Assistant Director of Nursing (ADON) HH revealed that she did not see any documentation that the IV fluid that was ordered on [DATE] was ever administered. Interview on 2/13/17 at 12:26 p.m., with R #2's attending physician SS revealed that she ordered the IV fluid on 12/5/16 because R #2's BUN (blood urea nitrogen) and creatinine (lab tests used to monitor kidney function) were elevated, and she thought that the resident may have been dehydrated. During further interview, physician SS revealed that she would be concerned for further dehydration if the resident did not receive the IV fluid that was ordered. Physician SS further revealed tha… | 2017-11-01 |
| 6661 | 6661 | LIFE CARE CTR OF LAWRENCEVILLE | 115659 | 210 COLLINS INDUSTRIAL WAY | LAWRENCEVILLE | GA | 30045 | 2016-11-04 | 314 | J | 1 | 0 | 03D012 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, resident and staff interviews, the facility's policy titled Pressure Ulcer Prevention (revised [DATE]), policy titled treatment of [REDACTED]., Screenings, and Assessments policy and procedure the facility failed to implement measures to prevent development of a pressure ulcer and failed to provide timely treatment for [REDACTED].#1. In addition to this, the facility failed to perform wound care as ordered for one resident (R) (#558); failed to perform accurate skin assessments for one resident (R #435); and failed to implement measures to prevent the development of a pressure ulcer for two residents (R #7, R #435). Ten residents were reviewed for pressure ulcers, and the sample size was 32 residents. On [DATE] a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation had caused, or had the likelihood to cause, serious injury, harm, impairment or death to residents. On [DATE] at 8:00 p.m. the facility's Divisional Vice President, Executive Director, Divisional Director of Clinical, the Director of Nursing, and the Regional Vice-President were informed of the jeopardy related to: F157:J, F281:J, F282:J, F314:J. On [DATE] at 3:43 p.m., the Executive Director was informed that Immediate Jeopardy had been identified at F223:J and F520:K in addition to F157:J, F281:J, F282:J, F314:J that were identified on [DATE]. The noncompliance related to the immediate jeopardy was identified to have existed on [DATE]. The immediate jeopardy continued through [DATE] and was removed on [DATE]. The facility implemented a Credible Allegation of Compliance related to the immediate jeopardy on [DATE]. The Immediate Jeopardy is outlined as follows: Resident #1 (R#1) was admitted to the facility on [DATE] with [MEDICAL CONDITION]/[MEDICAL CONDITION] after having a [MEDICAL CONDITIONS]. The resident was dependent on staff for Activities of Daily Living (AD… | 2017-11-01 |
| 6662 | 6662 | LIFE CARE CTR OF LAWRENCEVILLE | 115659 | 210 COLLINS INDUSTRIAL WAY | LAWRENCEVILLE | GA | 30045 | 2016-11-04 | 325 | D | 1 | 0 | 03D012 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff and physician interview, the facility failed to implement a nutritional supplement order in a timely manner, and failed to notify the physician and/or Registered Dietician (RD) of the refusal of the supplement for one resident (R) #2. Three residents were reviewed for nutrition concerns, and the sample size was 32 residents. Findings include: Review of the closed clinical records for R#2 revealed that she was admitted to the facility on [DATE] from the hospital with [DIAGNOSES REDACTED]. Review of a hospital Consultation report dated 11/24/16 revealed that the resident's appetite prior to admission to the facility was on the low side, and that her [MEDICATION NAME] was very low at 1.8. Review of an [MEDICATION NAME] level obtained on 12/16/16 revealed a result of 2.1 (normal range 3.5-5.0). Review of the Admission Minimum Data Set (MDS), for R#2, dated 12/7/16 revealed a Brief Interview for Mental Status (BIMS) score of 15 (a score of 13 to 15 is cognitively intact); independent for eating with setup help; and no weight loss or gain. Review of her care plans revealed that a care plan had been developed on 12/6/16 for Nutrition Risk, as evidenced by an [MEDICATION NAME] of 1.8 at hospital, possibly related to fluid overload; [MEDICAL CONDITION]; resident leaves 25% or more of food uneaten at most meals; [DIAGNOSES REDACTED]. Review of the approaches for this care plan included: Administer nutritional support as ordered. Nutrition shake 4 ounces BID (twice a day). Offer substitutes if 50% or less, of meal, is consumed. Refer for screen as needed to Registered Dietitian. Review of the Hospital Post-Acute Transfer Orders, for R#2, dated 11/30/16 revealed an order for [REDACTED]. Review of a Nutrition Data Collection/assessment dated [DATE] revealed that the current diet order was Reg. (Regular), Lactose free. Further review of this form revealed that the section for dislikes and special requests noted Lactose, and th… | 2017-11-01 |
| 6663 | 6663 | LIFE CARE CTR OF LAWRENCEVILLE | 115659 | 210 COLLINS INDUSTRIAL WAY | LAWRENCEVILLE | GA | 30045 | 2016-11-04 | 520 | J | 1 | 1 | 03D012 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, physician and staff interview, and review of the facility's Plan of Correction (POC), the facility failed to monitor and ensure that their Quality Assurance (QA) program was effective to correct the citations F 329, F 431, F 441, and F 514 that were cited during the Standard and Abbreviated survey conducted 10/31/16 through 11/4/16. The facility's Plan of Correction documents an alleged compliance date of 12/18/16. In addition, the facility failed to ensure that their QA program was effective in addressing the ongoing concerns related to pressure ulcers. The facility census was 92 residents (R). The sample size was 32 residents. On 2/10/17 a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation had caused, or had the likelihood to cause, serious injury, harm, impairment or death to residents. On 2/10/17 at 8:00 p.m. the facility's Divisional Vice President, Executive Director, Divisional Director of Clinical, the Director of Nursing, and the Regional Vice-President were informed of the jeopardy related to: F157:J, F281:J, F282:J, F314:J. On 2/13/17 at 3:43 p.m., the Executive Director was informed that Immediate Jeopardy had been identified at F223:J and F520:K in addition to F157:J, F281:J, F282:J, F314:J that were identified on 2/10/17. The noncompliance related to the immediate jeopardy was identified to have existed on 11/14/16. The immediate jeopardy continued through 2/15/17 and was removed on 2/16/17. The facility implemented a Credible Allegation of Compliance related to the immediate jeopardy on 2/14/17. The Immediate Jeopardy is outlined as follows: Resident #1 (R#1) was admitted to the facility on [DATE] with [MEDICAL CONDITION]/[MEDICAL CONDITION] after having a [MEDICAL CONDITIONS]. The resident was dependent on staff for Activities of Daily Living (ADL's) and was incontinent of bowel and bladder. The weekly Skin Integrity … | 2017-11-01 |
| 4135 | 4135 | ANDERSON MILL HEALTH AND REHABILITATION CENTER | 115145 | 2130 ANDERSON MILL RD | AUSTELL | GA | 30106 | 2017-03-08 | 323 | J | 1 | 0 | 03RZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based upon observation, record review, staff and family interviews the facility failed to provide an environment that was free of accident hazards, including one resident (R#1), with wandering and elopement behaviors and was wearing a Wanderguard, who was found in the parking lot, by staff, the evening of 9/28/2016 then who eloped from the facility's main door, on Saturday, 10/1/2016, and fell on the main road (Anderson Mill Road) sustaining a hematoma to the back of her head. This had the likelihood to affect eleven residents (R#1, R#2, R#3, R#4, R#5, R#6, R#7, R#8, R#9, R#10, and R#11) with wandering behaviors who wore Wanderguard bracelets. The facility's Interim Administrator, Director of Regulatory Compliance, and the Interim Director of Nursing (DON) were notified of the Immediate Jeopardy on 3/6/2017 at 2:00 p.m. The non-compliance related to the Immediate Jeopardy was identified to have existed on 9/28/2016, when R#1, wearing a Wanderguard bracelet, was found by staff in the parking lot and then on 10/1/2016 eloped through the front door of the facility and fell on the main road (Anderson Mill Road) sustaining a hematoma to the back of her head. The noncompliance related to the Immediate Jeopardy continued through 3/7/2017 and was removed on 3/8/2017. The Immediate Jeopardy is outlined as follows: The Immediate Jeopardy was related to the facility's non-compliance with the program requirements at 42 C.F.R.: 483.25(h), Accidents/Hazards (F323 S/S: J) 483.75, Administration (F490 S/S: J) 483.75(o)(1), Quality Assessment and Assurance Committee Members/Meet Quarterly/Plans (F520 S/S: (J) Additionally, Substandard Quality of Care was identified with the requirements at 42 C.F.R. 483.25(h), Accidents/Hazards (F323 S/S: J). On 3/8/2017, the facility provided a Credible Allegation Compliance (A[NAME]) of Jeopardy Removal alleging that interventions had been put into place to remove the immediate jeopardy on 3/8/2017. Although based on obse… | 2020-03-01 |
| 4136 | 4136 | ANDERSON MILL HEALTH AND REHABILITATION CENTER | 115145 | 2130 ANDERSON MILL RD | AUSTELL | GA | 30106 | 2017-03-08 | 490 | J | 1 | 0 | 03RZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on family and staff interviews, record review and review of the facility's Policy and Procedure for Elopement, it was determined the facility failed to be administered in a manner to investigate an Elopement of one resident (R#1) as to the cause and to prevent the likelyhood of elopement for the additional ten (10) at risk residents (R#2, R#3, R#4, R#5, R#6, R#7, R#8, R#9, R#10, and R#11) of a total of eleven residents with wandering behaviors and wearing a Wanderguard bracelet. The facility's Interim Administrator, Director of Regulatory Compliance, and the Interim Director of Nursing (DON) were notified of the Immediate Jeopardy on 3/6/2017 at 2:00 p.m. The non-compliance related to the Immediate Jeopardy was identified to have existed on 9/28/2016, the date a resident (R#1) wearing a Wanderguard, was found in the parking lot by staff on the 3:00 p.m. to 11:00 p.m. shift followed on 10/1/2017 when the resident eloped through the front door of the facility and fell on the main road (Anderson Mill Road) sustaining a hematoma to the back of her head. The noncompliance related to the Immediate Jeopardy continued through 3/7/2017 and was removed on 3/8/2017. The Immediate Jeopardy is outlined as follows: The Immediate Jeopardy was related to the facility's non-compliance with the program requirements at 42 C.F.R.: 483.25(h), Accidents/Hazards (F323 S/S: J) 483.75, Administration (F490 S/S: J) 483.75(o)(1), Quality Assessment and Assurance Committee Members/Meet Quarterly/Plans (F520 S/S: (J) Additionally, Substandard Quality of Care was identified with the requirements at 42 C.F.R. 483.25(h), Accidents/Hazards (F323 S/S: J). On 3/8/2017, the facility provided a Credible Allegation Compliance (A[NAME]) of Jeopardy Removal alleging that interventions had been put into place to remove the immediate jeopardy on 3/8/2017. Based on observations, record reviews and review of the facility's policies as outlined in the Credible Allegation of Comp… | 2020-03-01 |
| 4137 | 4137 | ANDERSON MILL HEALTH AND REHABILITATION CENTER | 115145 | 2130 ANDERSON MILL RD | AUSTELL | GA | 30106 | 2017-03-08 | 520 | J | 1 | 0 | 03RZ11 | **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 maintain a Quality Assurance Performance Improvement (QAPI) committee that identified, developed and implemented corrective action plans to correct a problem of the Wanderguard System not functioning properly to prevent the Elopement of one resident (R#1) and to ensure that ten (R#2, R#3, R#4, R#5, R#6, R#7, R#8, R#9, R#10, and R#11) additional residents with wandering behavior, who were wearing Wanderguards bracelets did not exit the facility unattended. The facility's Interim Administrator, Director of Regulatory Compliance, and the Interim Director of Nursing (DON) were notified of the Immediate Jeopardy on 3/6/2017 at 2:00 p.m. The non-compliance related to the Immediate Jeopardy was identified to have existed on 9/28/2016, when R#1, wearing a Wanderguard bracelet, was found by staff in the parking lot and then on 10/1/2016 eloped through the front door of the facility and fell on the main road (Anderson Mill Road) sustaining a hematoma to the back of her head. The noncompliance related to the Immediate Jeopardy continued through 3/7/2017 and was removed on 3/8/2017. The Immediate Jeopardy is outlined as follows: The Immediate Jeopardy was related to the facility's non-compliance with the program requirements at 42 C.F.R.: 483.25(h), Accidents/Hazards (F323 S/S: J) 483.75, Administration (F490 S/S: J) 483.75(o)(1), Quality Assessment and Assurance Committee Members/Meet Quarterly/Plans (F520 S/S: (J) Additionally, Substandard Quality of Care was identified with the requirements at 42 C.F.R. 483.25(h), Accidents/Hazards (F323 S/S: J). On 3/8/2017, the facility provided a Credible Allegation Compliance (A[NAME]) of Jeopardy Removal alleging that interventions had been put into place to remove the immediate jeopardy on 3/8/2017. Based on observations, record reviews and review of the facility's policies as outlined in the Credible Allegat… | 2020-03-01 |
| 6652 | 6652 | LIFE CARE CENTER | 115654 | 176 LINCOLN AVE | FITZGERALD | GA | 31750 | 2013-06-13 | 253 | B | 0 | 1 | 03S111 | Based on observations, the facility failed to provide housekeeping and maintenance services to maintain a sanitary and comfortable environment for two (2) (West and South) of four (4) units. Findings include: West Wing: Observations conducted 6/10/13 at 2:46pm; 6/11/13 at 8:34am ; 6/12/13 at 8:15am and on 6/13/13 between 8:39am and 11am, revealed the following: Rooms W-2 and W-7 had a heavy accumulation of dust on the bathroom ceiling vents. Room W-24 the air conditioner vent cover had a heavy accumulation of dust/debris Room W-8 bathroom threshold has missing a section of tile Shower room next to room W-26 had a black substance on the floor around the edges and corners of the room Shower room next to room W-8 the floor had black substance around the edges and corners, also the ceiling vent had a heavy dust build up Exit door leading out to the fenced yard had approximately 1.5 to 2-inch gap at the bottom across the entire width of the door. Ceiling vent in the hallway outside of room W-7 had a heavy accumulation of dust The cobase in all hallways and the dining areas had heavy accumulation of dust and debris. There was a dark substance on the floor under the water fountain. Dried liquid spills were on the bases of the overbed tables in room W-17 and room W-21 B-bed Room W-17 had window curtains that were unraveled and frayed. Nine (9) chairs in the large dining room and six (6) chairs in the small dining room were scuffed and dusty. The air conditioning covers in the small dining room were dusty and had food debris on them. South Wing: Observations conducted during initial tour on 6/11/13 at 11:59 am revealed the following: The doors leading into the common shower rooms were heavily scuffed and marred revealing most of the previous paint. The dining room had accumulated dust and debris on the window sills and air conditioning unit. | 2017-11-01 |
| 6653 | 6653 | LIFE CARE CENTER | 115654 | 176 LINCOLN AVE | FITZGERALD | GA | 31750 | 2013-06-13 | 282 | D | 0 | 1 | 03S111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review and staff interview the facility failed to provide necessary care in accordance to the resident's plan of care for one (1) resident (#95) from a sample of thirty-three (33) residents. Findings include: Observation conducted on 6/10/13 at 11:35 am revealed resident #95 was sitting in wheelchair at a table in dining room. Further observation revealed a white/gray hair that was approximately 3/4-inch in length on the resident's chin and facial hair above the lips. Observation conducted on 6/11/13 at 8:55 am revealed resident #95 was sitting in her wheelchair in the hallway outside of dining hall on the end of East Hall. Continued observation revealed facial hair above the lip and on the chin. Observations conducted on 6/11/13 1:02 pm and 6/12/13 at 8:14am revealed resident #95 sitting in her wheelchair in the dining room on the end of East Hall. Each observation revealed that the resident had a long chin hair and facial hair above the upper lip and below the lower lip. Review of the plan of care for resident #95 dated 3/30/13 revealed that the resident had a self care deficit and required assistance from staff with bathing, grooming and personal hygiene. Continued review revealed the goal for the resident was to be clean, well groomed and shaved daily and as needed. Review of the Quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed under section G the resident was assessed as total assistance with one person assist for personal hygiene and bathing. Interview on 6/12/13 at 10:35 am with the Certified Nursing Assistant (CNA) CC revealed she acknowledged that resident #95 had long facial hair and it should be shaved. | 2017-11-01 |
| 6654 | 6654 | LIFE CARE CENTER | 115654 | 176 LINCOLN AVE | FITZGERALD | GA | 31750 | 2013-06-13 | 371 | D | 0 | 1 | 03S111 | Based on observations and staff interview it was determined the facility failed to properly store and label frozen inventory in a safe and sanitary manner in one (1) of two (2) freezers located in the kitchen. Findings include: Observation of the kitchen conducted on 6/10/13 at 11:30 a.m. revealed four plastic bags in the chest freezer containing meat products. One of the bags was opened and not re-closed. The open bag was not labeled identifying the contents and/or identifying the date received/opened. Observation conducted on 6/12/13 at 8:45 a.m. revealed a brown unopened bag in the freezer that had two small tears in the bag. There was no label on this bag indicating its contents. A date written on the bag with a marker was 6/6/12. Interview with the dietary manager on 6/12/13 at 8:45 a.m. revealed, after picking up the bag, that she believed the bag contained french fries. She further revealed that the date on the bag was the date it was received. Interview with the administrator on 6/12/13 1:40 p.m. revealed he expected stock used within 6 months. | 2017-11-01 |
| 6655 | 6655 | LIFE CARE CENTER | 115654 | 176 LINCOLN AVE | FITZGERALD | GA | 31750 | 2013-06-13 | 431 | E | 0 | 1 | 03S111 | Based on observations and staff interview, it was determined that the facility failed to ensure that six (6) of six (6) medication carts on four (4) of four (4) wings did not contain expired medications. Findings include: During observations of six (6) medication carts conducted 6/12/13 between 1:01 p.m. and 1:45 p.m. the following expired medications were noted: West Wing: Cart 1 -One (1) bottle of Aspirin Enteric Coated 325 milligram 100/bottle had an expiration date of February 2013 but was not opened until 3/22/13. -One (1) bottle of Aspirin 81 milligram 300/bottle with expiration date of January 2013 and an opened date of 1/29/13. Interview on 6/12 /13 at 1:01 p.m. with Licensed Practical Nurse (LPN) AA revealed that she confirmed these medications were being administered to residents. Cart 2 -One (1) bottle of Aspirin Enteric Coated 325 milligram 100/bottle had an expiration date of January 2013 but a date opened of 2/28/13. -One (1) bottle of Aspirin 81 milligram 300/bottle had an expiration date of January 2013 but an opened date of 4/4/13. North Wing Cart 1 -One (1 ) bottle of Folic Acid .4 milligram 100/bottle with an expiration date of April 2013 and the opened date was 2/16/13. East Wing Cart 1 -One(1) bottle of B12 100 micrograms 130/bottle with expiration date of May 2013 and an opened date of 6/10/13. South Wing Cart 1 -One (1) bottle of Aspirin 81 milligram 300/bottle with an expiration date of January 2013 and an opened date of 12/13/12 Cart 2 -One (1) bottle of Aspirin Enteric Coated 325 milligram 100/bottle with an expiration date of May 2013 and an opened date of 2/1/13. Interview on 6/12/13 at 1:45 p.m. with LPN BB revealed these medications were being administered to residents. During an interview with the Director of Nursing on 6/13/13 at 1:32 p.m., she stated that the nurses assigned to the medication carts were responsible for checking medication expiration dates and removing the medications from the carts when noted to be expired. | 2017-11-01 |
| 6656 | 6656 | LIFE CARE CENTER | 115654 | 176 LINCOLN AVE | FITZGERALD | GA | 31750 | 2013-06-13 | 441 | D | 0 | 1 | 03S111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interviews, it was determined that the facility failed to ensure that the staff followed infection control standards when passing ice to residents on one (1) (West) of four (4) units and that two (2) employees' files from thirteen (13) employee files reviewed had evidence of screening for communicable diseases. Findings include: 1. Review of 13 employee personnel health records revealed that 2 employees did not have current screenings for [DIAGNOSES REDACTED]. The health record for the activity director hired on 12/10/10 did not have evidence of a purative protein derivative (PPD) skin test, chest X-ray, or current physical evaluation to determine that the employee was free of [DIAGNOSES REDACTED] symptoms. The dietary manager had been re-hired by the facility on 8/29/12 however, the only physical evaluation found in the file and was dated 9/2/11 and the PPD skin test was dated 12/15/11. Interview on 6/13/13 at 1:50 p.m. with the administrative staff member who maintains the personnel records, revealed that there were no other current test results for the two employees. 2. Observation conducted on 6/10/13 at 1:05 p.m. during the lunch meal on the West Unit, revealed a certified nursing assistant (CNA) opened the ice chest on the cart in the hallway. The lid of the ice chest came off landing on the floor with the inside of the lid down. The lid was picked up by another CNA who placed it back onto the ice chest without cleaning/sanitizing the lid. Further observation revealed five residents were served ice from the ice chest after the lid had fallen on the floor. Interview with the Director of Nursing (DON) on 6/13/13 at 2:20 p.m., revealed the (DON) would have expected staff to clean/sanitize the lid before placing it back onto the ice chest. | 2017-11-01 |
| 8609 | 8609 | OAKS - SCENIC VIEW SKILLED NURSING, THE | 115393 | 205 PEACH ORCHARD ROAD | BALDWIN | GA | 30511 | 2011-09-15 | 325 | D | 0 | 1 | 03WJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to provide additional calories to a resident to address her ongoing weight loss. This affected one (1) resident, #49, from a sample of twenty-eight (28) residents. Findings include: Record review for resident #49 revealed a that she had a significant weight loss of 14 pounds (12.2%) from 3/02/11 to 9/12/11 and a significant weight loss of 6 pounds (5.5% ) from 7/07/11 to 8/07/11. Further record review revealed that the resident had a physician's orders [REDACTED]. The Med Pass supplement was increased to 120 ml three (3) times per day beginning on 8/18/11. A review of the resident's Medication Administration Records (MAR) revealed that the resident consumed 100% of the supplement on most occasions when it was given to her. A review of the resident's Yearly Weight Record revealed that the resident lost another 1.4 pounds of weight from 8/21/11 to 9/12/11. A review of Physician Telephone Orders revealed that the Med Pass supplement was discontinued on 9/06/11 even though the resident continued to lose weight. An interview with the facility's Registered Dietitian (RD) and the facility's Assistant Director of Nursing (ADON) on 9/14/11 at 12:30 p.m. confirmed that the resident was continuing to lose weight and could not explain why the resident's supplement was discontinued. The interview also revealed that they could not explain why another supplement was not ordered to replace the caloric loss when the supplement was discontinued. | 2015-12-01 |
| 5786 | 5786 | SUMMERHILL ELDERLIVING HOME & CARE | 115430 | 500 STANLEY STREET | PERRY | GA | 31069 | 2014-07-24 | 371 | D | 0 | 1 | 03XV11 | Based on observation and staff interview the facility failed to ensure that food items were properly labeled in the walk-in freezer affecting all resident's in the facility (census=152) except for thirteen (13) residents who received total nutrition via a gastrostomy tube. Findings include: Observation on 07/21/14 at 11:35 a.m. of the walk-in freezer revealed a food item sitting on top of a case of frozen chicken with no label or date. This unidentifiable food items was tan in color, wrapped in plastic wrap, and was twelve (12) inches in length, six (6) inches in width, and five (5) inches in thickness. Continued observation revealed that the kitchen manager removing the plastic wrap from the food item to identify the contents. Interview on 07/21/14 at 11:40 a.m. with the kitchen manager revealed that he expects the dietary staff to label food items before placing them in the freezer or refrigerator. The kitchen manager confirmed that he was not able to identify the tan food item without taking the plastic wrap off. Further interview with the Kitchen Manger revealed that after the plastic wrap was removed from the food item he was still was not able to identify the food item. | 2018-05-01 |
| 5787 | 5787 | SUMMERHILL ELDERLIVING HOME & CARE | 115430 | 500 STANLEY STREET | PERRY | GA | 31069 | 2014-07-24 | 372 | E | 0 | 1 | 03XV11 | Based on observation and staff interview the facility failed to properly contain food waste in the dumpster and surrounding area to prevent the harborage of pest for three of four days of the survey. Findings include: Observation on 07/21/14 at 12:00 p.m. of the facilities dumpster area revealed that the facility had two (2) large dumpsters which were positioned on asphalt. The dumpster to the right had an off white mushy food substance that contained eggs shells located on the ground near the front left corner. The food substance covered an area that was two (2) feet in length and eight (8) inches in width. Continued observation of this dumpster revealed the off white food substance was smeared and streaking down the front left side from the top to the ground. Further observation revealed that there were abundant amount of flies surrounding the dumpster area and were in the off white food substance. Observation on 07/22/14 at 3:45 p.m. revealed that the right dumpster continued to have the off white food substance smeared and streaking down the front left corner. Continued observation revealed that there were several flies around the area were the food debris was located. Observation on 07/23/14 at 12:05 p.m. of the dumpster area revealed that the right dumpster continued to have the off white food substance on the front left side. Continued observation of this dumpster revealed an unidentifiable food item that was pale yellow in color, four (4) inches in length and one (1) inch in width located on the ground near the front left corner. Further observation revealed that there numerous flies around the food debris. Interview on 07/21/14 at 12:00 p.m. with the Kitchen Manager revealed that he expects the area surrounding the dumpsters to be clean. He confirmed that there was an off white food substance on the ground and on the front of the dumpster. Interview on 07/23/14 at 12:05 p.m. with the Kitchen Manager revealed that he verified that there was an off white food substance smeared on the front of the dumpster … | 2018-05-01 |
| 153 | 153 | HABERSHAM HOME | 115099 | HIGHWAY 441 NORTH, BOX 37 | DEMOREST | GA | 30535 | 2018-05-02 | 584 | E | 0 | 1 | 04GG11 | Based on observations and staff interviews, the facility failed to ensure a clean, comfortable, homelike environment during meal service in one of two dining rooms (West Wing Dining Room). Specifically, the facility failed to clean up food, debris and utensils from the floor after first dining. This failure resulted in an unclean dining experience for residents that were scheduled for meal service during second dining. Findings include: Observation of the West Wing Dining Room on 4/30/18 at 12:24 p.m. revealed the first meal for lunch was served at 12:24 p.m. There were two tables on the left of the dining room with seated residents, a small half circular table to the back right with seated residents and one long table on the right side of the dining room with seated residents. There was one small table closer to the kitchen that was not occupied. At 1:08 p.m. a staff member began collecting clothing protectors left on the tables by residents that had finished their lunch. At 1:12 p.m. the Dietary Aide brought a large garbage bin and a cart with dish bins to the dining room. The staff began collecting plates, utensils and cups from the tables. The staff washed the tables with sanitizer wipes. Residents were noted outside the hall waiting for the second dining service. Observed on the left end of the long table was a large piece of dinner roll, food crumbs and pieces hash brown casserole under the table on the floor and the chair on the end had food crumbs on it. The back-left table towards the aisle side had a packet of saltine crackers and pieces if mixed vegetables (green beans and carrots) on the floor under the table. At 1:17 p.m. a resident with a walker came to sit on the left end of the long table. The resident was observed sweeping the crumbs off the chair with her clothing protector before she sat down. The resident then looked down at the floor and held her feet to the side so she would not put her feet on the dinner roll and hash brown casserole on the floor. The resident had to ask the staff to remove… | 2020-09-01 |
| 154 | 154 | HABERSHAM HOME | 115099 | HIGHWAY 441 NORTH, BOX 37 | DEMOREST | GA | 30535 | 2018-05-02 | 600 | D | 0 | 1 | 04GG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident, family, and staff interviews, review of the facility's Abuse Prohibition Policy and Procedure revised, 12/17, The facility failed to ensure that an allegation of verbal/mental abuse was reported to the State Agency (SA) and that a thorough investigation related to the allegation of verbal/mental abuse was done for one resident (R#74). Findings Include: Review of the Abuse Prohibition Policy and Procedure revealed that Abuse is also defined as any intentional or grossly negligent act or series of acts or intentional or grossly negligent omission to act which causes injury to a resident, including, but not limited to, assault or battery, failure to provide treatment or care, or sexual harassment of the resident. Verbal abuse is defined as any use of oral, written or gestured language that willfully includes disparaging and derogatory terms to residents or their families, or within their hearing distance, regardless of their age, ability to comprehend d, or disability. Examples of verbal abuse include, but are not limited to: threats of harm; saying things to frighten a resident such as telling a resident that she will never be able to see her family again. Mental abuse includes but is not limited to humiliation, harassment, threats of punishment or deprivation. Investigation: Once a complaint or situation is identified involving alleged mistreatment, neglect, or abuse, including injuries of unknown source and misappropriation of resident property, the following investigation and reporting procedures will be followed: 1. The description of the alleged complaint. 2. Information gathering. 3. Document the description of the injury. 4. Interviews will be conducted of all pertinent parties. 5. Past performances and/or previous incidents. 6. Describe actions taken by facility to protect resident. 7. All investigation information will be kept on file in a secured location. Record review for R#74 revealed the resident … | 2020-09-01 |
| 155 | 155 | HABERSHAM HOME | 115099 | HIGHWAY 441 NORTH, BOX 37 | DEMOREST | GA | 30535 | 2018-05-02 | 761 | D | 0 | 1 | 04GG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and policy review, the facility failed to discard expired medication in one of four medication carts. The sample size is 24. Findings include: During medication pass on [DATE] at 8:45 a. m., with Licensed Practical Nurse (LPN) BB, revealed an opened multiple-dose vial of [MEDICATION NAME] R insulin with opened date of [DATE]. A label on the vial read discard after 28 days. Expired [DATE]. Review of the facility policy titled, Pharmacy Services and Procedure policy, revised (YEAR), indicated that the facility should ensure that medications and biological's have an expiration date on the label and have not been retained longer than recommended by the manufacturer or supplier. The policy further states facility should record the date opened on the medication container, if the medication has a shortened expiration date. Review of the policy titled, Recommend Minimum Medication Storage Parameters, revised (YEAR), indicated multiple-dose vials for injection, are to be dated when opened, and discard unused portions after 28 days or in accordance with manufacturer's recommendations. Interview on [DATE] at 8:45 a.m. LPN BB stated the policy for opened injectable medications is 28 days. She verified the opened bottle of [MEDICATION NAME] R insulin of [DATE] had an open date and pharmacy sticker indicated to discard after 28 days from opening date which is [DATE]. Interview on [DATE] at 9:15 a.m., Director of Nursing stated the policy for open injectable medications have a duration time, [MEDICATION NAME] 28 days. She verified the open bottle of [MEDICATION NAME] R insulin had [DATE] open date and the pharmacy sticker indicated to discard after 28 days from opening date which is [DATE]. Interview on [DATE] at 11:00 a.m., Pharmacy Consultant stated the policy for open injectable medications have a duration time, [MEDICATION NAME] 28 days. He verified the medication was refilled and sent to facility on [DATE], the open bott… | 2020-09-01 |
| 156 | 156 | HABERSHAM HOME | 115099 | HIGHWAY 441 NORTH, BOX 37 | DEMOREST | GA | 30535 | 2018-05-02 | 835 | D | 0 | 1 | 04GG11 | Based on record review, resident, family, and staff interviews, review of the facility's Abuse Prohibition Policy and Procedure revised, 12/17, The Adminstrator failed to ensure an allegations of verbal/mental abuse was reported to the State Agency (SA) and that a thorough investigation related to the allegation of verbal/mental abuse was done for one resident (R#74) Finding include: During interview with R#74 on 4/30/18 at 12:00 p.m., in the resident's room, revealed that she had a nurse talk in an inappropriate manner to her. Resident stated her daughter would be there soon and ask that I speak with her because the stroke she had affects her ability to talk clearly. On 4/30/18 at 12:30 p.m. R #74's daughter requested the surveyor to speak with her with her Mom present. Upon entering the room R #74's roommate was not in the room and at the daughter request the door was shut to allow a private conversation. Daughter states that on Monday of the previous week her Mom was having a lot of pain and had refused her shower. She states a nurse told R #74 that if she didn't take a shower she would pick her up and throw her in the shower and this upset R #74 and she told the nurse she was not taking a shower because she was in a lot of pain and having a bad day. Daughter then stated that the nurse said, If you don't take a shower you will not get any more pain medication. Daughter states she called in a complaint to the Ombudsman who said she would get back with her but states she hasn't heard from her yet. Also states that she complained to the head nurse. During the interview R #74 would shake her head in agreeance to everything her daughter was telling me. R #74 stated that the nurse was joking but it was not funny. On 5/2/18 2:45 at p.m.during interview with the Administrator and DON revealed that the Administrator did not report the Allegation because the Ombudsman was involved already. Administrator was given a copy of the regulation regarding reporting allegations of abuse to the State Agency within 2 hours if ther… | 2020-09-01 |
| 10400 | 10400 | ETOWAH LANDING | 115348 | 809 SOUTH BROAD ST | ROME | GA | 30161 | 2009-07-14 | 203 | E | 1 | 0 | 04R611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and family interview, it was determined that the facility failed to notify the resident, and a family member or legal representative, of hospital transfer in writing either before, at the time of, or since the transfer for four (4) residents ("A", #2, #3 and #4) in a survey sample of four (4) residents. Findings include: 1. Record review for Resident "A" revealed a Nurse's Note of 06/11/2009 which documented that the resident was transferred to the hospital. However, further record review revealed no evidence to indicate that either before, at the time of, or since this hospital transfer, the resident and the resident's family had received a written transfer notice indicating the reason for the transfer, the effective date of the transfer, the location to which the resident was being transferred, a statement that the resident had the right to appeal the transfer, and the ombudsman's name, address and telephone number. During an interview with the family of Resident "A" on conducted on 07/14/2009, the family member stated that no written transfer notice had been provided when the resident was transferred to the hospital. 2. Record review for Resident #2 revealed a Nurse's Note which documented that Resident #2 was transferred to the hospital on [DATE]. There was, however, no evidence to indicate that either before, at the time of, or since this hospital transfer, the resident and the resident's family had received a written transfer notice indicating the reason for the transfer, the effective date of the transfer, the location to which the resident was being transferred, a statement that the resident had the right to appeal the transfer, and the ombudsman's name, address and telephone number. 3. Record review for Resident #3 revealed a Nurse's Note which documented that the resident was transferred to the hospital on [DATE] at 11:45 a.m. There was, however, no evidence to indicate that either before, at… | 2014-07-01 |
| 10401 | 10401 | ETOWAH LANDING | 115348 | 809 SOUTH BROAD ST | ROME | GA | 30161 | 2009-07-14 | 205 | E | 1 | 0 | 04R611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and family interview, it was determined that the facility failed to provide written information to the resident, and family member or legal representative, either at the time of, or since, hospital transfer, that specified the duration of the bed-hold policy for four (4) residents ("A", #2, #3 and #4) in a survey sample of four (4) residents. Findings include: 1. Record review for Resident "A" revealed a Nurse's Note of 06/11/2009 which documented that the resident was transferred to the hospital. There was, however, no evidence to indicate that either at the time of, or since, this hospital transfer, the resident and the resident's family had received written information regarding the duration of the facility's bed-hold policy. During interview with the family member of Resident "A" conducted on 07/14/2009 at 11:00 a.m., it was stated that no written notification specifying the duration of the bed hold policy was provided at the time of resident's transfer to the hospital. 2. Record review for Resident #2 revealed a Nurse's Note which documented that Resident #2 was transferred to the hospital on [DATE]. There was, however, no evidence to indicate that either at the time of, or since, this hospital transfer, the resident and the resident's family had received written information regarding the duration of the facility's bed-hold policy. 3. Record review for Resident #3 revealed a Nurse's Note which documented that the resident was transferred to the hospital on [DATE] at 11:55 a.m. There was, however, no evidence to indicate that either at the time of, or since, this hospital transfer, the resident and the resident's family had received written information regarding the duration of the facility's bed-hold policy. 4. Record review for Resident #4 revealed a Nurse's Note which documented that the resident was transferred to the hospital on [DATE]. There was, however, no evidence to indicate that either a… | 2014-07-01 |
| 4604 | 4604 | HABERSHAM HOME | 115099 | HIGHWAY 441 NORTH, BOX 37 | DEMOREST | GA | 30535 | 2015-07-24 | 166 | D | 0 | 1 | 053U11 | Based on family interview, staff interviews, record review and review of the Grievances and Complaints Policy, the facility failed to provide prompt efforts to resolve a grievance for one (1) resident (A) from a sample of twenty-five (25) residents. Findings include: An interview conducted on 7/21/15 at 1:21 p.m. with the daughter of resident A revealed that approximately a week ago, she noticed a large bruise on her mother's stomach and prior to that, she had a large bruise on her right hip. She said she took pictures and reported it to Licensed Practical Nurse (LPN) BB on duty and asked if she knew how the bruises occurred. BB looked at the pictures and stated she had no idea how the bruises were obtained and that nothing had been reported to her. Continued interview revealed that she told BB that she wanted the bruises looked at and wanted to know what happened. Resident A daughter further revealed that it has been a week since she has made the complaint and she has not received any follow up or any explanation as to how the bruises occurred. An interview conducted on 7/22/15 at 3:20 p.m. with both the Director of Nursing (DON) and the Social Worker revealed that they were unaware of any bruises on resident A or any complaints made by the daughter. The Social Worker said there were no documented complaints related to bruising in the Grievance Log. The DON said all Grievances are investigated and followed up with the complainant. The DON said the proper procedure for this complaint should have been an assessment of the bruising and an incident report should have been conducted by the LPN that received the complaint. The DON acknowledged that the proper procedure for documentation and filing a grievance was not followed. The Social Worker said she would immediately file a grievance, resident A would be assessed for bruising and the daughter would be notified. An interview conducted on 7/22/15 at 3:35 p.m. with LPN BB who was on duty at the time the complaint was made revealed that it was the end of her shift whe… | 2019-08-01 |
| 4605 | 4605 | HABERSHAM HOME | 115099 | HIGHWAY 441 NORTH, BOX 37 | DEMOREST | GA | 30535 | 2015-07-24 | 282 | D | 0 | 1 | 053U11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, family interview and staff interviews, the facility failed to follow care plan interventions for one (1) resident (A) receiving anticoagulant therapy from a sample of twenty-five (25) residents. Findings include: Resident A was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The resident was receiving Aspirin 81 milligrams(mg) daily and [MEDICATION NAME] 75 mg daily. A review conducted of the care plan dated 6/11/15 identified resident A is on anticoagulant medication with interventions that include, but not limited to, daily skin inspections, monitor/document/report as needed any adverse reactions of anticoagulant therapy which includes bruising. An interview conducted on 7/21/15 at 1:21 p.m. with the daughter of resident A revealed that approximately a week ago, she noticed a large bruise on her mother's stomach and prior to that, she had a large bruise on her right hip. She said she took pictures and reported it to Licensed Practical Nurse (LPN) BB on duty and asked if she knew how the bruises occurred. BB looked at the pictures and stated she had no idea how the bruises were obtained and that nothing had been reported to her. An interview conducted on 7/22/15 at 3:28 p.m. with the second shift Certified Nursing Assistant (CNA) EE revealed that she has worked with resident A for a long time and is very familiar with her. EE said she does remember noticing a bruise on the resident's right hip last week and reported it to the nurse but she does not remember which nurse she reported it to. An interview conducted on 7/22/15 at 3:35 p.m. with LPN BB who was on duty at the time the complaint was made revealed it was the end of her shift when the daughter for resident A came to her to show a picture of a large bruise on the resident's lower stomach. BB confirmed the bruise on resident A lower stomach. Continued interview revealed that she passed it on in report to the night shift nurse and instructed her to r… | 2019-08-01 |
| 4606 | 4606 | HABERSHAM HOME | 115099 | HIGHWAY 441 NORTH, BOX 37 | DEMOREST | GA | 30535 | 2015-07-24 | 371 | E | 0 | 1 | 053U11 | Based on observation and staff interviews, the facility failed to ensure foods were at the appropriate temperature to prevent potential food borne illness which had the potential to affect forty-five (45) resident that received an oral diet that was not mechanically altered. Findings include: An observation conducted on 7/22/15 at 12:36 p.m. with Dietary Aide DD revealed that the fried chicken on the steam table was not at the appropriate temperature. The top pieces of chicken measured one hundred degrees Fahrenheit (100 F)and the bottom pieces of chicken measured one hundred and twenty-five (125 F). An interview conducted on 7/22/15 at 12:39 p.m. with DD revealed that the food was delivered from the hospital and placed on the steam table. Temperatures are checked upon arrival from the hospital but at no other time during serving. DD further revealed that they do not have reheating capabilities in the satellite kitchen and food has to be sent back to the hospital to be reheated. An interview conducted on 7/23/15 at 9:00 a.m. with the Director of Nursing (DON) revealed that after investigation, it was found, the left side of the steam table had not been turned on. | 2019-08-01 |
| 6622 | 6622 | BONTERRA TRANSITIONAL CARE & REHABILITATION | 115555 | 2801 FELTON DRIVE | EAST POINT | GA | 30344 | 2013-08-28 | 252 | B | 0 | 1 | 05JI11 | Based on observations, family, and staff interviews the facility failed to maintain an odor-free environment on one (1) of two (2) wings (East). Findings include: Observations conducted from 8/25/13 at 3:00pm until 8/28/13 at 8:30am revealed the following: On 8/25/13 at 3:00pm and 3:25pm resident room 133 had strong urine odor. On 8/26/13 at 10:00am resident room 133 smelled of urine. On 8/26/13 at 9:45am resident room 135 had an extremely strong odor of urine. On 8/26/13 at 2:00pm resident rooms 133, 135, and the common area had strong urine odors. 8/26/13 at 2:45pm resident room 108, had a strong urine odor. 8/27/13 at 10:15am strong urine odors in East wing atrium area. 8/28/13 at 8:30am resident rooms 133 and 135 had strong urine odors. Interview with a family member of resident OO conducted 8/25/13 at 3:00pm revealed that the family member visits at least two (2) times per month, and the room usually smelled of urine. An pervasive odor of urine was noted in the room during the interview. Interview with the Housekeeping Director DD on 8/28/13 at 9:35am revealed facility used an enzyme called Foul Odor Digester to break up feces/urine odors. Floor cleaners were Emerald and Liminate, both have a good smell. No family or visitors had complained of odors to the manager. Facility staff had requested housekeeping for particular odors in a particular room, and they were addressed. Deep cleaning for resident rooms are done one (1) time per month including walls, doors, floors, furniture. Compliance tours are completed morning and evening on the day shift. There are no housekeeping staff on evening or night shift. Interview with the Licensed Practical Nurse (LPN) EE on 8/28/13 at 10:00am revealed if odors are identified, housekeeping is alerted, they are prompt in attempting to rid the unit or room of odor. EE further indicated that when a urine odor is noted, the resident is checked for incontinence, as well as the room to locate the source of odor, and then the appropriate staff are notified to take care of that iss… | 2017-11-01 |
| 6623 | 6623 | BONTERRA TRANSITIONAL CARE & REHABILITATION | 115555 | 2801 FELTON DRIVE | EAST POINT | GA | 30344 | 2013-08-28 | 281 | D | 0 | 1 | 05JI11 | Based on medication pass observation, review of facility policy and staff interviews, the facility failed to ensure that appropriate procedure was used when checking for placement and residual of a gastrostomy/peg tube for one (1) resident (#8) from a sample of twenty seven (27) residents. Findings include: Observation of the morning medication pass conducted 8/26/13 revealed that the Licensed Practical Nurse (LPN) FF used ten (10) cubic centimeters (cc) of water to check the placement of the peg tube for resident #8. She did not check for residual. Interview conducted 8/27/13 at 9:30AM with medication nurse FF revealed that the procedure she used to check peg placement was to place a stethoscope on the abdomen, then insert 10cc of water and then listen to hear if water goes into the stomach. FF then indicated she would administered medications and make sure no residual. She indicated that she had been inserviced and instructed to check for placement using 10cc of water. Interview conducted 8/26/13 at 1:30PM with the Director of Nursing revealed as per nursing practice and facility policy the nurse should insert a small amount of air into the tube with the syringe and listen to stomach with stethoscope for gurgling sounds and check residual. She revealed that the nurse should not have inserted 10cc of water into the tube to check for placement. Review of the facility policy for Enteral Tubes revealed that placement of the tube should be checked by inserting a small amount of air into the tube and then with the stethoscope listen to the stomach for gurgling sounds. | 2017-11-01 |
| 6624 | 6624 | BONTERRA TRANSITIONAL CARE & REHABILITATION | 115555 | 2801 FELTON DRIVE | EAST POINT | GA | 30344 | 2013-08-28 | 315 | D | 0 | 1 | 05JI11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, review of facility policy/procedures, inservice records and staff interviews the facility failed to ensure that a urinary catheter was secure for one (1) resident (#48) from a sample of twenty-seven (27) residents. Findings Include: Record review revealed that resident #48 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Further record review revealed the resident also has Traumatic [DIAGNOSES REDACTED] from his chronic indwelling Foley. Observation of catheter care for this resident was conducted 8/26/13 at 2:40 PM and revealed there was no catheter strap in use. Review of facility policy indicated that a catheter strap was to be used to anchor the catheter to a resident leg to prevent trauma. Interview with treatment nurse AA conducted 8/26/13 at 2:45 PM revealed that the resident was born with Hypospadious and due to long term use of Foley catheter that area has reopened. AA further revealed that Urology consults have been conducted but have decided not to repair Hypospadious. The resident receives wound care daily and as necessary with Foley care. During a second interview with AA on 8/26/13 at 3:15 PM, she acknowledged that resident #48 did not have a catheter strap in use. Interview with the Director of Nursing on 8/27/13 at 9:00 AM revealed that her her expectation is that each resident with a Foley catheter will have a leg strap to secure catheter as per policy. Interview with Registered Nurse (RN) CC conducted 8/27/13 at 10:15 AM revealed all Certified Nursing Assistants (CNA) are trained on catheter care per facility's nursing standard of practice. CNAs are trained that a catheter strap is to be used to anchor the catheter to a resident's leg, to prevent trauma. | 2017-11-01 |
| 7386 | 7386 | ST JOSEPH'S TRANSITIONAL CARE UNIT | 115640 | 11705 MERCY BOULEVARD | SAVANNAH | GA | 31419 | 2013-01-24 | 287 | E | 0 | 1 | 05LU11 | Based on record review and staff interview the facility failed to transmit Minimum Data Set assessments to the Centers for Medicare and Medicaid database system in the required time period. Findings include: An offsite review of a Georgia Minimum Data Set (MDS) 3.0 Missing OBRA Assessment report dated 1/16/13 revealed that the facility had a total of twenty-nine (29) resident assessments which had not been submitted to the Centers for Medicare and Medicare (CMS) database system . The late MDS assessments were for a time period of 10/07/10 to 09/07/12. An interview with a MDS office employee (AA) on 1/21/13 at 2:00 revealed that the assessment program used by the facility (Meditech) is supposed to transmit completed assessments to the CMS system after they are signed off by a Registered Nurse. Employee AA further stated in the interview that apparently the software program is not transmitting the completed assessments properly and the staff has no way to verify the error. | 2017-05-01 |
| 7387 | 7387 | ST JOSEPH'S TRANSITIONAL CARE UNIT | 115640 | 11705 MERCY BOULEVARD | SAVANNAH | GA | 31419 | 2013-01-24 | 356 | C | 0 | 1 | 05LU11 | Based on observation and staff interview the facility failed to post and retain required staffing information in a public accessible area on a daily basis. Findings include: During the initial tour of the facility on 1/21/13 at 8:00 a.m. it was observed that required information related to facility name, current date, total number and the actual hours worked by licensed and unlicensed nursing staff directly responsible for resident care per shift, and the resident census was not posted anywhere in the facility. This was confirmed in an interview with the facility's Program Director on 1/21/13 at 11:45 a.m. The Program Director also confirmed in the interview that the facility had not retained the posted daily nurse staffing data for a minimum of 18 months. | 2017-05-01 |
| 7388 | 7388 | ST JOSEPH'S TRANSITIONAL CARE UNIT | 115640 | 11705 MERCY BOULEVARD | SAVANNAH | GA | 31419 | 2013-01-24 | 441 | E | 0 | 1 | 05LU11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview, the facility failed to thoroughly clean the glucometer in between each resident use. Three (3) of four (4) residents (#87, #105, #109) on the unit that received fingerstick blood sugar measurements (FSBS) were observed. The sample size was sixteen (16) residents. Findings include: On 01/23/13 beginning at 11:40 a.m., Patient Care Technician (PCT) BB was observed performing FSBS measurements using a [MEDICATION NAME] glucometer. The glucometer was thoroughly cleaned with a disinfectant wipe prior to performing the first FSBS for resident #87 in their room. Afterwards, PCT BB removed the strip reader from the glucometer machine and cleaned this part only, using an alcohol wipe. The glucometer was then taken into resident #109's room and placed on the over-bed table while the FSBS was done. Afterwards, the only part of the glucometer that was cleaned was the strip reader. A FSBS was done next for resident #105 while they were in the rehab department. When done, the strip reader was the only part of the glucometer cleaned with alcohol before placing it back in the machine. During interview with PCT BB prior to performing the final FSBS, she verified that she only cleaned the strip reader portion of the glucometer in between each blood sugar that she did, and that the entire glucometer was cleaned only before beginning and after finishing all of the FSBS's. During interview with Registered Nurse Infection Control Coordinator CC on 01/23/13 at 12:00 p.m., he stated his expectation was that the whole glucometer should be cleaned with alcohol or a disinfectant wipe after each resident use. Upon further interview, he stated that the facility's policy was to clean the glucometer after use, not just part of the glucometer. Review of the facility's Patient Care Policy on Equipment: Cleaning and Disinfecting Non-critical Patient Care Equipment noted that glucometer surfaces must be cleaned and disin… | 2017-05-01 |
| 7389 | 7389 | ST JOSEPH'S TRANSITIONAL CARE UNIT | 115640 | 11705 MERCY BOULEVARD | SAVANNAH | GA | 31419 | 2013-01-24 | 520 | E | 0 | 1 | 05LU11 | Based on record review and staff interview, the facility failed to ensure that the Director of Nurses (DON) or a representative was in attendance at three (3) of the past four (4) Quality Assurance (QA) Committee meetings, and failed to ensure that there was physician representation at any of the QA meetings between March and August 2012. The unit census was ten (10) residents. Findings include: Review of the facility's Quality Assurance (QA) Staff Meeting sign-in sheets revealed that the DON did not attend any of the quarterly meetings on 01/18/12, 03/14/12, 08/22/12, and 11/21/12. During interview with the facility's Program Director on 01/23/13 at 12:45 p.m., she verified that the DON did not attend the QA meetings in January and March. During further interview, she stated that there was no full-time DON in August and November, and that a charge nurse had been assigned to attend in the DON's place only at the August meeting. The Program Director added that none of the monthly QA meetings held between March and August had physician representation. | 2017-05-01 |
| 1060 | 1060 | ROME HEALTH AND REHABILITATION CENTER | 115363 | 1345 REDMOND ROAD | ROME | GA | 30165 | 2018-06-14 | 690 | D | 0 | 1 | 05V811 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, and review of policy, the facility failed to ensure that the catheter tubing and drainage bag for one resident (#48) of 21 sampled residents were positioned to ensure that these items did not come in contact with the floor as the resident moved about the facility in her wheelchair. Findings include: Review of policy Indwelling Urinary Catheter (Foley) Care and Management last revised (MONTH) 17, (YEAR) revealed instructions for staff to keep the drainage bag below the level of the patient's bladder to prevent backflow, but to not place the drainage bag on the floor to reduce the risk of contamination and subsequent Catheter-associated Urinary Tract Infections (CAUTI). Review of the clinical records for resident (R)#48 revealed the resident was admitted on [DATE] with a [DIAGNOSES REDACTED]. A review of the Admission Minimum Data Set (MDS) assessment of 3/22/18 revealed the resident had an indwelling catheter with an active [DIAGNOSES REDACTED]. Review of the current physician's orders [REDACTED]. Observation on 6/13/18 at 10:35 a.m. revealed R#48 sitting just inside the doorway of her room with her catheter tubing and drainage bag hanging under her wheelchair, both touching the floor. Observation on 6/13/18 at 11:20 a.m. revealed the resident sitting in hallway outside of her room with the drainage bag and catheter tubing resting on the floor. Observation on 6/13/18 12:00 p.m. revealed the resident sitting at a table in the dining room awaiting the lunch service. The resident's drainage bag and catheter tubing hung below her wheelchair, resting on the floor. Observation on 6/14/18 at 10:26 a.m. revealed R#48 sitting in the hallway outside her room with her catheter tubing and drainage resting on the floor below her wheelchair. Observation on 6/14/18 at 10:35 a.m. revealed Licensed Practical Nurse (LPN), DD pushing R#48 into her room and closing the door. When the LPN reemerged with the resident from the … | 2020-09-01 |
| 1861 | 1861 | PREMIER ESTATES OF DUBLIN, LLC | 115495 | 1634 TELFAIR STREET | DUBLIN | GA | 31021 | 2018-10-17 | 573 | D | 1 | 0 | 062G11 | > Based on record review, family interview and staff interview, it was determined that the facility failed to provide requested medical records in two (2) days, as required, to the family of one resident (R#1) and failed to provide requested medical records to the attorneys of two (2) residents (R#4 and R#5). The sample size was of 3 residents. Findings include: Review of an undated paperwork from the Power of Attorney (POA) for R#1 revealed a request for a full and complete copy of medical records. Review of paperwork from the attorney for R#4 dated 7/9/18 revealed a request for medical, administrative files, and billing records. Review of paperwork from the attorney for R#5 dated 3/30/18 with a hand-written note dated 7/20/18 for a second request revealed a request for a complete certified copy of all office notes, diagnostic reports, daily clinical notes, prognosis and itemized billing. Review of the Resident Information and Reference Guide dated (MONTH) (YEAR) revealed on page 22 under the section Right to Inspect and Copy; With some exceptions, you have the right to review and copy your medical information. You must submit your request in writing to the Facility. We may charge a fee for the costs of copying, mailing or other supplies associated with your requests. Further review revealed on page 42 (2) (i) Upon an oral or written request, to access all records pertaining to himself or herself including current clinical records within 24 hours (excluding weekends and holidays): and (ii) After receipt of his or her records for inspection, to purchase at a cost not to exceed the community standard photocopies of the records or any portions of them upon request and 2 working days advance notice to the facility. Interview on 9/26/18 at 2:38 p.m. with the Administrator revealed R#1 ' s POA requested his brother's records. The POA was told he would need to complete a form and provide a copy of the POA to the facility. Interview on 9?26/18 at 2:39 p.m. the Medical Records personnel revealed the POA of R#1 brought a … | 2020-09-01 |
| 9554 | 9554 | CHESTNUT RIDGE NSG & REHAB CTR | 115423 | 125 SAMARITAN DRIVE | CUMMING | GA | 30040 | 2011-11-10 | 156 | E | 0 | 1 | 06HO11 | Based on record review and staff interview the facility failed to maintain copies of approved, standardized Advance Beneficiary Notices with all required information completed. The facility also failed to provide evidence that the notices were provided far enough in advance to allow sufficient time for the beneficiary to consider all available options and failed to provide evidence that residents and/or their responsible parties were given the opportunity to make choices related to their future coverage. This affected all residents (census = 136) whose Medicare coverage ended while they were residing in the facility. Findings include: Record review for residents receiving Part A and Part B Medicare benefits revealed that the facility did not maintain the proper documents related to options available to residents when their benefits ended. The records maintained by the facility also did not include page 1 of form CMS- which indicated the date that the resident's skilled services ended. The facility also was unable to produce copies of forms CMS- and CMS-R-131 which allowed these residents or their responsible parties to request a demand bill to pay for continued skilled services after their Part A or Part B medicare coverage ended. | 2015-06-01 |
| 9555 | 9555 | CHESTNUT RIDGE NSG & REHAB CTR | 115423 | 125 SAMARITAN DRIVE | CUMMING | GA | 30040 | 2011-11-10 | 279 | D | 0 | 1 | 06HO11 | Based on record review and staff interview the facility failed to develop a plan of care with interventions related to a therapeutic diet for one (1) resident, resident #44, on a sample of thirty-five (35) residents. Findings include: On 11/08/11 at 3:00 p.m. review of the care plan for resident # 44 dated 8/10/11 and reviewed on 11/02/11 revealed that there were no plan of care related to a therapeutic diet for diabetes, interventions initiated related to supplements or potential for weight loss. Interview with the Licensed Practical Nurse (LPN) Unit Manager on 11/8/11 at 2:15 p.m. revealed that the dietary department is responsible for the nutrition care plan. Interview with the Minimum Data Set (MDS) Coordinator on 11/8/11 at 2:40 p.m. revealed that resident # 44 triggered on the Care Area Assessment (CAAs) documentation and the dietary department stated they would care plan for nutrition but it was never developed. Cross refer to F 325 | 2015-06-01 |
| 9556 | 9556 | CHESTNUT RIDGE NSG & REHAB CTR | 115423 | 125 SAMARITAN DRIVE | CUMMING | GA | 30040 | 2011-11-10 | 325 | D | 0 | 1 | 06HO11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview the facility failed to ensure that a therapeutic diet ordered by the physician was initiated for one (1) resident, resident #44 on a sample of thirty-five (35) residents. Findings include: During dining observation on 11/07/11 at 1:15 p.m. resident #44 received a regular diet with a mighty shake. On 11/08/2011 at 8:00 a.m. and 1:15 p.m. resident #44 received a regular diet for breakfast and lunch. Record review revealed the Minimum Data Set ((MDS) dated [DATE] assessed resident # 44 as being on a therapeutic diet. Review of the Registered Dietician (R.D.) notes dated 8/15/11 revealed that she recommended a No Concentrate Sweets (NCS) diet related to the [DIAGNOSES REDACTED]. Observation of the resident on 11/07/11 at 1:00 p.m. and on 11/08/11 at 8:00 a.m. and at 1:00 p.m. revealed that resident # 44 received a regular diet for all three meals. In addition, she received a mighty shake for lunch both meals that was not sugar-free. The resident also received ice cream for lunch on 11/08/11. Interview with the Licensed Practical Nurse (LPN) Unit Manager on 11/08/11 at 2:15 p.m. revealed that the resident should have received a NCS diet. The LPN Unit Manager stated that the nursing staff are responsible for sending diet changes to the dietary department. Interview with the Dietary Manager (DM) on 11/08/11 at 2:20 p.m. revealed that she had not received a change in diet orders for resident # 44 and the resident has been receiving a regular diet since her admission on 7/21/11. The Mighty Shake was ordered on [DATE] to be given with lunch and was supposed to be sugar-free. | 2015-06-01 |
| 9557 | 9557 | CHESTNUT RIDGE NSG & REHAB CTR | 115423 | 125 SAMARITAN DRIVE | CUMMING | GA | 30040 | 2011-11-10 | 514 | D | 0 | 1 | 06HO11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview the facility maintain accurate documentation related to drug dosage for one (1) resident, resident # 4 on a sample of thirty-five (35) residents. Findings include: Record review of the medications for resident # 44 revealed that she was on [MEDICATION NAME] 40 milligrams by mouth at 6:30 a.m. for reflux. The current monthly Physician order [REDACTED]. Observation of the current medication blister pack was [MEDICATION NAME] 20 milligrams by mouth at 6:30 a.m. with eight pills missing. Review of the current Medication Administration Record [REDACTED]. Interview with the Director of Nurses (DON) on 11/09/11 at 8:00 a.m. revealed that the order is for [MEDICATION NAME] 40 mg and the pharmacy sent the wrong medication. She stated that they used floor stock for the drug and she did not know why the pharmacy sent the blister pack of [MEDICATION NAME] for this resident. Interview with the Administrator on 11/09/11 at 8:10 a.m. revealed that she would call the pharmacist and clarify what strength they have been sending for this resident. On 11/09/11 at 9:15 a.m. the Administrator brought the surveyor documentation from the pharmacy that the order was changed on 11/02/11 with the consent of the physician. The pharmacist stated that the current orders were printed on 10/23/11 and this change did not make the current orders. However, he stated they did send the [MEDICATION NAME] 20 milligrams for November and the staff has been giving the 20 milligrams and documenting that they are giving 40 milligrams. Interview with the Administrator on 11/09/11 at 9:35 a.m. confirmed that the pharmacy had sent the [MEDICATION NAME] 20 milligrams for resident # 44 and the nursing staff had given it but documented that they were giving [MEDICATION NAME] 40 milligrams. | 2015-06-01 |
| 6879 | 6879 | SPARTA HEALTH AND REHABILITATION | 115382 | 11744 HIGHWAY 22 E | SPARTA | GA | 31087 | 2013-03-28 | 156 | C | 0 | 1 | 06L711 | Based on record review and staff interview, the facility failed to provide the Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) (CMS form ) for three of three residents reviewed (#38, #40, and #77) who were discharged from Medicare Part A services and remained in the facility. The facility also failed to ensure that the Notice of Medicare Non-Coverage (CMS form ) was received by the responsible party (RP) for one resident (#38), and that the CMS form was provided prior to termination of services for one resident (#40). Findings include: During interview on 3/27/13 at 8:00 a.m., the facility's Financial Controller stated that the CMS form Notice of Medicare Non-Coverage was the only notice that she was aware of that had been provided for a resident or RP when a resident was discharged from Medicare Part A services but, the Social Services Director (SSD) was responsible for issuing those notices. The Financial Controller verified that residents #38, #40, and #77 had not used up their 100 days of Part A eligibility, and that all three remained in the facility after termination of skilled services. Review of resident #38's Notice of Medicare Non-Coverage form (CMS form ) revealed that there was no evidence that the resident's responsible party had received the notice. Review of resident #40's Notice of Medicare Non-Coverage form (CMS form ) revealed that his/her skilled services ended on 12/23/12 but, the form was not signed by the resident until 12/26/12. During an interview on 03/27/13 at 12:50 p.m., the SSD stated that he mailed the CMS form to the RP when a resident was discharged from skilled services. He said that was the only form he provided even if the resident stayed in the facility. The SSD stated that he had mailed the CMS form to resident #38's RP, and tried to reach them by telephone to determine if they wanted to appeal the decision to terminate the skilled services but, he did not document that information. The SSD verified that resident #40 did not sign the Notice of Medicare Non-Coverage… | 2017-09-01 |
| 6880 | 6880 | SPARTA HEALTH AND REHABILITATION | 115382 | 11744 HIGHWAY 22 E | SPARTA | GA | 31087 | 2013-03-28 | 160 | C | 0 | 1 | 06L711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to convey the balances in three of three deceased residents' trust fund accounts (#55, #77, and one randomly-reviewed resident account) to the individual or probate jurisdiction administering the residents' estates within thirty (30) days of death. Findings include: 1. Resident #55 died on [DATE]. However, his/her personal funds were not conveyed until [DATE] (56 days after death). 2. Resident #77 died on [DATE]. However, his/her personal funds were not conveyed until [DATE] (48 days after death). 3. A randomly selected resident dies on [DATE]. However, his/her funds were not conveyed until [DATE] (56 days after death.) During an interview on [DATE] at 10:15 a.m., the facility's Financial Controller stated that they tried to close residents' trust fund accounts within thirty days of death. However, she verified that it had not been done within 30 days of death for residents #55, #77 and the randomly selected resident. | 2017-09-01 |
| 6881 | 6881 | SPARTA HEALTH AND REHABILITATION | 115382 | 11744 HIGHWAY 22 E | SPARTA | GA | 31087 | 2013-03-28 | 241 | D | 0 | 1 | 06L711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, it was determined that the facility failed to ensure the dignity of one resident (#15) during dining and while in bed in a sample of 35 residents. Findings include: Resident #15 had [DIAGNOSES REDACTED]. Licensed staff coded the resident as totally dependent for eating and bed mobility on the 12/27/12 Minimum Data Set (MDS) assessment. There was a care plan since 7/27/12 to address the resident's need for total assistance with activities of daily living because of his/her muscle contractures, [MEDICAL CONDITION], and cognitive and communication deficits. There was an intervention for restorative services when eating for swallowing when eating. However, staff failed to promote the resident's dignity when he/she was in bed and failed to assist the resident with eating in a timely manner. 1. During an observation on 3/16/13 at 9 a.m., resident #15 was in bed and the lower half of his/her body was visible from the entrance of his/her room. Although the privacy curtain had been partially pulled, the resident's lower body and incontinence brief were visible from the hall. At 10:10 a.m., there were two certified nursing assistants (CNAs) in the resident's room next to his/her bed. The lower half of the resident's body and brief were still visible from the hall. After the CNAs left the resident's room, he/she was in bed with a shirt and brief on but, remained exposed to the hall. 2. Observation of the lunch meal in the main dining room on 3/25/13 at 12:47 p.m. revealed that resident #15 was seated in a Broda chair at a table with two other residents. Although staff had served his/her meal, there was no assistance provided until 1:05 p.m The other residents ate and completed their lunch prior to the resident having received assistance from staff to eat. | 2017-09-01 |
| 6882 | 6882 | SPARTA HEALTH AND REHABILITATION | 115382 | 11744 HIGHWAY 22 E | SPARTA | GA | 31087 | 2013-03-28 | 253 | D | 0 | 1 | 06L711 | Based on observations and staff interview, it was determined that the facility failed to ensure clean personal care resident equipment for one resident (#15) in a sample of 35 residents. Findings include: During observations on 3/25/13 at 2:18 p.m., 3/26/13 at 9:45 a.m. and 12:40 p.m., 3/27/13 at 8:15 a.m., 9:20 a.m., and 12:51 p.m., and on 3/28/13 at 8:15 a.m., there were multiple dried stains on the cushions and arm rests of the Broda chair used by resident #15. During observation and an interview on 3/28/13 at 8:50 a.m., the Director of Nurses (DON) observed the stained Broda chair in use for resident #15. She stated that anyone could have wiped down the cushions when they observed them dirty and stained. | 2017-09-01 |
| 6883 | 6883 | SPARTA HEALTH AND REHABILITATION | 115382 | 11744 HIGHWAY 22 E | SPARTA | GA | 31087 | 2013-03-28 | 282 | D | 0 | 1 | 06L711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview, the facility failed to implment care plan interventions and restorative plans to provide range of motion (ROM) exercises during bathing for one resident (Q), and to apply a knee brace and palm guard device for one resident (#48) in a sample of three residents with contractures and reviewed for potential ROM concerns in a total sample of 35 residents. Findings include: 1. During an interview on 3/25/13 at 1:38 p.m., Licensed Practical Nurse (LPN) AA stated that resident Q had contractures of his/her hands and knees. On 03/25/13 at 3:19 p.m., resident Q was observed to have contractures of his/her fingers, wrists, and knees. Licensed staff had coded the resident on the 2/26/13 annual Minimum Data Set (MDS) assessment as having functional limitations in range of motion of the upper and lower extremities on both sides, and with no cognitive impairment. There was a care plan to address the resident's needs in the area of activities-of daily living because of [MEDICAL CONDITION] and contractures with an intervention for nursing staff to provide passive ROM (PROM) exercises to the resident's extremities with the bath. However, on 03/27/13 at 10:00 a.m., Certified Nursing Assistants (CNA) BB and CC were observed giving resident Q a bedbath. The only time the resident's limbs were observed to be manipulated was to bend them just enough to remove or put on the resident's clothing. After the bath was completed, CNA BB applied splints to the resident's hands and lower arms but, did not provide PROM exercises. During an interview at 12:35 p.m., resident Q stated that there was a staff member who would do ROM for a few minutes but, it was not done every day. During an interview on 3/28/13 at 12:00 p.m., the LPN MDS Coordinator/Restorative Coordinator verified the care plan intervention was for nursing staff to provide PROM exercises to the resident's extremities with the bath. See F318 for additional… | 2017-09-01 |
| 6884 | 6884 | SPARTA HEALTH AND REHABILITATION | 115382 | 11744 HIGHWAY 22 E | SPARTA | GA | 31087 | 2013-03-28 | 318 | D | 0 | 1 | 06L711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews with a resident and staff, and record review, it was determined that the facility failed to ensure that passive range of motion (PROM) exercises were done as planned for one resident (Q) and that positioning devices to prevent further contractures were in use for one resident (#48) in a sample of three residents with contractures in a total sample of 35 residents. Findings include: 1. Resident # 48 had [DIAGNOSES REDACTED]. Licensed staff coded him/her on the 1/10/13 Minimum Data Set (MDS) assessment as having limitations in his/her upper and lower extremities. There was a care plan since 10/29/12 to address the resident's need for total care with activities-of-daily living because of [MEDICAL CONDITION] and contractures. There were interventions for gentle passive range of motion (PROM) with bathing and to refer to the restorative intervention plan. There was a 12/17/11 Functional Program form with a documented plan for staff to apply a palm guard on the resident's right hand following gentle PROM to the hand. There was a 11/21/11 Functional Program form for PROM to both of the resident's legs. There was a 2/13/13 Functional Program form for staff to apply bilateral knee extension braces and a hip abduction brace. There was a Functional program, established 2/15/13 for the resident to wear bilateral knee extension braces for four hours during the morning shift, and for the use of a hip abduction brace to separate both legs that could be applied the whole day. During observations on 3/27/13 at 10:45 a.m., the restorative certified nursing assistant (CNA) provided passive range of motion exercises to the resident's upper and lower extremities but, did not apply the knee extension braces and the palm guard. At 1:24 p.m., there were no knee extension braces and palm guard in use on the resident. On 3/28/13 at 8:10 a.m., during an observation and interview with a CNA in the room with resident # 48, there were no … | 2017-09-01 |
| 7304 | 7304 | LAKE CITY NURSING AND REHABILITATION CENTER LLC | 115535 | 2055 REX ROAD | LAKE CITY | GA | 30260 | 2012-12-20 | 312 | D | 0 | 1 | 06T811 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, facility policy and procedure review, and staff interviews the facility failed to ensure acceptable grooming and personal hygiene for two (2) residents (#187 and #224) from a sample of twenty five (25) residents. Findings include: 1. Observation of resident #187 accompanied by a Certified Nursing Assistant (CNA) BB on 12/19/12 at 9:00 am revealed the resident's brief was soaked with urine; the draw sheet and bed sheet were also wet. Further observation on 12/19/12 at 1:3 revealed the resident was leaving the dining room accompanied by a family member. The resident was wet with urine, soaked through to the front of the pants he/she was wearing; a brief was in place. Review of the most recent Quarterly Minimum Data Set (MDS) assessment dated [DATE] indicated the resident needed extensive assistance with one (1) person physical assist with all activities of daily living (ADLs). Review of the care plan dated 10/17/12 indicated the resident had frequent episodes of urinary incontinence with hyper tonicity (over active bladder). Interventions were in place for the resident to receive incontinence care as needed. Interview with CNA BB on 12/19/12 at 9:00 am revealed the resident had not been assessed for incontinent needs since her shift began at 7:00 am. Further interview with BB at 1:4 revealed that the resident had been changed after his bath at approximately 10:00 am, and again before lunch. She was not aware he was wet during lunch. 2. Observation of resident # 224 on 12/18/12 at 9:30 am, 12/19/12 at 9:30 am, and 12/20/12 at 9:15 am revealed he had long, greasy hair with white flakes covering his head. Review of the most recent MDS assessment dated [DATE] indicated the resident was totally dependent for bathing, with one (1) person physical assist. The care plan dated 9/24/12 indicated interventions in place for assistance with bathing. Further review of the facility daily shower sheets indicated the residen… | 2017-06-01 |
| 7305 | 7305 | LAKE CITY NURSING AND REHABILITATION CENTER LLC | 115535 | 2055 REX ROAD | LAKE CITY | GA | 30260 | 2012-12-20 | 328 | E | 0 | 1 | 06T811 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, staff interviews, and review of facility policy regarding oxygen and tube feeding, the facility failed to ensure that oxygen equipment was properly maintained for thirteen (13) of twenty two (22) residents receiving respiratory care, Findings include: During rounds to check oxygen concentrators, tracheotomies, and nebulizers on 12/19/12 at 2:30 p.m. with the Director of Nursing (DON) the following was identified: room [ROOM NUMBER] P- The outside of the concentrator had a thick crusty yellow substance on it, the filter had a thick coat of gray dust, and there was no date on the humidifier or nasal cannula room [ROOM NUMBER] A- Oxygen concentrator filters were covered with a thick layer of dust from 12/17/12 through 12/20/12. room [ROOM NUMBER] A- The filter on the concentrator was missing and the intake where the filter belonged was filled with dust. room [ROOM NUMBER] B- There was no filter on the oxygen concentrator and the intake where the filter belonged was filled with dust. room [ROOM NUMBER] A- There was no filter on the oxygen concentrator. room [ROOM NUMBER] A- Oxygen concentrator had a thick layer of dust on both filters. room [ROOM NUMBER] B- Oxygen concentrator filter with thick layer of dust. room [ROOM NUMBER] B- Nebulizer was observed lying on the floor and a thick layer of dust on the concentrator filter. room [ROOM NUMBER] A- Oxygen concentrator filter had a thick layer of dust. room [ROOM NUMBER] B- Oxygen concentrator filter had a thick layer of dust. room [ROOM NUMBER] B- Oxygen humidifier was dated 11/26/12. room [ROOM NUMBER] A- Oxygen concentrator filter had a thick layer of dust. room [ROOM NUMBER] A- Oxygen concentrator filter had a thick layer of dust and oxygen tubing was lying on the floor. Interview with the DON on 12/19/12 at 3:00 p.m. revealed that the concentrator filters were dirty and needed to be cleaned. Further interview revealed that the filters were to be cleaned wee… | 2017-06-01 |
| 7306 | 7306 | LAKE CITY NURSING AND REHABILITATION CENTER LLC | 115535 | 2055 REX ROAD | LAKE CITY | GA | 30260 | 2012-12-20 | 431 | D | 0 | 1 | 06T811 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interviews, the facility failed to discard medications beyond the manufacturer's expiration date and/or failed to discard medication that was open beyond 28 days on one (1) of four (4) medication carts and the east hall medication room. Findings include: 1. Observation of the 600 Hall medication cart on 12/19/12 at 12:04 p.m. revealed a bottle of Famotidine 10 milligram (mg) tablets dated as opened 10/4/11 initially with 30 tablets;.there were 2 tablets remaining in the bottle .The expiration date for the Famotidine was 11/12. 2. Observation of the east hall medication room on 12/12/12 @ 12:13 pm revealed the following expired medications: [REDACTED] -Zinc sulfate (floor stock)expired 2/12- 2 bottles -Multidose 0.9% Sodium Chloride 5ml expired on 9/12 -Ipratropium Bromide .02% Inhalation Solution x 2 boxes -expired on [DATE] -Albuterol .083% expired on 10/12 | 2017-06-01 |
| 9882 | 9882 | EAST LAKE ARBOR | 115482 | 304 FIFTH AVENUE | DECATUR | GA | 30030 | 2011-12-29 | 312 | D | 1 | 0 | 076N11 | Based on record review, the facility failed to provide the necessary activities of daily living care for one (1) resident ("A") from a survey sample of five (5) residents. Findings include: Record review for Resident "A" revealed a Care Plan entry of 06/06/2011 which identified Resident "A" as having dementia and as requiring total assistant with all activities of daily living. An Approach was to inspect the resident's skin and nails with care daily and to trim the nails as needed unless contraindicated. Another identified problem on the Care Plan of 06/06/2011 was the resident being at risk for skin breakdown due to incontinence of bowel and bladder, with Approaches which included keeping the resident's skin clean and dry, and providing prompt pericare after each incontinent episode. However, written documentation submitted by the family of Resident "A" on 09/26/2011 documented that upon transfer to another nursing facility (receiving facility) earlier in the month of September 2011, at the time of arrival at the receiving nursing facility, the resident was noted to have a significant rash which staff at the receiving facility identified as being scalding due to poor personal hygiene/incontinence care at the transferring facility. An Admission Skin Condition note of the receiving facility dated 09/17/2011 documented that upon arrival, Resident "A"'s sacral area was red/blanchable, and the resident had extremely dry and scabby feet. The resident's toes were very dry and dirty, and had an odor between the toes. Additionally, some of the resident's toenails were long, very dry and thick. Review of the transferring facility's medical record for Resident "A" revealed no evidence to indicate that the resident had any rash or unmet nail care/skin issues at the time of transfer, and no evidence to indicate that the resident had refused care or was contraindicated for nail trimming. | 2015-04-01 |
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CREATE TABLE [cms_GA] ( [facility_name] TEXT, [facility_id] INTEGER, [address] TEXT, [city] TEXT, [state] TEXT, [zip] INTEGER, [inspection_date] TEXT, [deficiency_tag] INTEGER, [scope_severity] TEXT, [complaint] INTEGER, [standard] INTEGER, [eventid] TEXT, [inspection_text] TEXT, [filedate] TEXT );