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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 6693 | 6693 | WOODRUFF MANOR, LLC | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2014-04-02 | 333 | E | 0 | 1 | PVQF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, interview and record review, the facility and the consultant pharmacist failed to ensure residents were free of significant medication errors on 2 of 4 medication carts. The findings included: On 3/31/14 at approximately 1:10 PM, inspection of the medication cart for rooms 101A - 110B revealed the following: -One 10 ml vial of [MEDICATION NAME] Insulin 100 U (units)/ml belonging to Resident #10, dated by the facility as having been opened 2/7/14 and bearing a pharmacy label to Discard after 42 days from opening. The vial contained approximately 2 ml and according to manufacturer's package insert should have been discarded 42 days after opening or 3/21/14. A record review showed a physician's orders [REDACTED]. Further review of the MAR (medication administration record) showed that the insulin was still in use as of the 9:00 PM dose on 3/30/14, and that 9 doses had been administered past the expiration date. This finding was verified by LPN # 1 on 3/31/14 at approximately 1:20 PM -One 10 ml vial of [MEDICATION NAME] R 100 U/ml belonging to Resident #10, dated by the facility as having been opened 2/7/14 and bearing a pharmacy label to Discard after 28 days from opening. The vial contained approximately 6 ml and according to manufacturer's package insert should have been discarded 28 days after opening or 3/7/14. Record review showed a physicians order for Sliding scale [MEDICATION NAME] R Insulin checks to be done four times daily; (Accuchecks) at 6:30 AM, 11:30 AM, 4:30 PM and 9:00 PM. A review of the MAR indicated [REDACTED]. This finding was verified by LPN # 1 on 3/31/14 at approximately 1:20 PM. On 3/31/14, inspection of the medication cart for rooms 212A - 227B revealed the following: -One opened vial of Latanoprost 0.005% (percent) Eye Drops belonging to Resident A was found in the eye drop drawer. This vial had been dated by the facility as expiring 42 days after opening or 3/24/14. Rec… | 2017-11-01 |
| 6694 | 6694 | WOODRUFF MANOR, LLC | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2014-04-02 | 425 | E | 0 | 1 | PVQF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observations, interviews, manufacturer package insert and manufacturer labeling, the facility and consultant pharmacist failed to follow a procedure to ensure that expired medications were not stored with other medication in 2 of 2 medication rooms and in 2 of 4 medication carts. The findings included: On 3/31/14 at approximately 11:20 AM, inspection of the Hall 200 medication room refrigerator revealed the following: -One opened and undated 1 ml (milliliter) floor stock vial of Tuberculin, Purified Protein Derivative Aplisol 5 TU (test units)/0.1 ml Lot 8. This vial contained approximately 0.5 ml. The manufacturer's vial stated: Discard opened product after 30 days. The manufacturer's package insert stated: Discard vials in use for more than 30 days because of possible oxidation and degradation that may affect potency. This finding was verified by RN (Registered Nurse) #1 on 3/31/14 at approximately 11:25 AM. On 3/31/14 at approximately 11:37 AM, inspection of the Hall 100 medication room refrigerator revealed the following: -One opened and undated 1 ml (milliliter) floor stock vial of Tuberculin Purified Protein Derivative (Mantoux) Tubersol 5 test units per test, lot C4461AA. The vial contained approximately 0.5 ml. The manufacturer's vial stated: Discard opened product after 30 days. The manufacturer's package insert stated: Discard vials in use for more than 30 days because of possible oxidation and degradation that may affect potency. This finding was verified by LPN (Licensed Practical Nurse) #1 on 3/31/14 at approximately 11:50 AM. On 3/31/14 at approximately 1:10 PM, inspection of the medication cart for rooms 101A - 110B revealed the following: -One 10 ml vial of Levemir Insulin 100 U (units)/ml belonging to Resident #10, dated by the facility as having been opened 2/7/14 and bearing a pharmacy label to Discard after 42 days from opening. The vial contained approximately 2 ml, and according to the… | 2017-11-01 |
| 6695 | 6695 | WOODRUFF MANOR, LLC | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2014-04-02 | 441 | D | 0 | 1 | PVQF11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, record review, interviews, and review of the policy provided by the facility entitled, Handwashing/Hand Hygiene, the facility failed to provide a sanitary environment to prevent the spread of infection. Observation revealed one staff member failed to wash his/her hands prior to leaving the room of a resident who was on contact precautions. The findings included: Observation on 4/1/14 at 11:55 AM revealed staff passing out lunch trays on the 200 Unit. The staff members were using hand sanitizer to clean their hands between residents. Certified Nursing Assistant (CNA) #1 was observed donning a gown and gloves prior to entering a resident's room (Resident #11). Resident #11 was the only resident in the facility on contact precautions for[DIAGNOSES REDACTED] colitis. CNA #1 was observed setting up the resident's tray and prompting the resident to eat a bite of food by placing the spoon in the resident's hand. CNA #1 was then observed going into the bathroom where s/he removed the Personal Protective Equipment (PPE), opened the trash bin, and disposed of the PPE. CNA #1 did not wash his/her hands after removing the PPE; and attached a velcro stop sign across the resident's doorway after having exited the room. The surveyor stopped the staff member and told her/him that s/he had not washed his/her hands. CNA #1 stated that s/he planned on using hand sanitizer before going to get the next tray. CNA #1 then took a small container of hand sanitizer out of his/her pocket and used this to disinfect his/her hands. S/he then went back to assist with passing out lunch trays. The surveyor stopped the CNA and asked him/her to go and wash his/her hands. A review of the policy provided by the facility entitled Handwashing/Hand Hygiene revealed a Policy Statement that This facility considers hand hygiene the primary means to prevent the spread of infections. According to information included in the policy, staff … | 2017-11-01 |
| 6696 | 6696 | WOODRUFF MANOR, LLC | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2014-04-02 | 465 | D | 0 | 1 | PVQF11 | On the days of the survey, based on observation and interview, the facility failed to provide a safe and comfortable environment by failing to repair or replace bedroom doors with missing veneer on 2 of 2 units. The findings include: Observation throughout the facility on 4/1/14 at 3:00 PM revealed there were three bedroom doors with pieces of missing veneer. Room #111 had chipped veneer in multiple areas on the outside of the door. Room #202 was missing a piece of veneer on the outside bottom left corner of the door. Room #213 had missing veneer in multiple areas on the outside of the door with sharp edges noted. A tour of the facility was conducted with the Maintenance Director on 4/2/14 at 9:20 AM. Interview with the Maintenance Director during this tour revealed the missing veneer had not been reported to him by anyone. Interview with the facility Administrator on 4/2/14 at 9:49 AM revealed the missing veneer on the doors had not been identified as a concern and there were no plans at the time to repair or replace the doors. | 2017-11-01 |
| 7544 | 7544 | WOODRUFF MANOR, LLC | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2014-01-15 | 274 | D | 1 | 0 | 0VTO11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Complaint Inspection, based on record review and interview, the facility failed to perform a significant change assessment for 1 of 1 resident with a significant change in their condition. Resident # 1 had a significant decline in s/he's condition with no significant change assessment. The findings included: The facility admitted Resident #1 with [DIAGNOSES REDACTED]. Review of the medical record revealed the Annual Minimum Data Set ((MDS) dated [DATE] coded the resident coded as independent with supervision needed with her/his Activities of Daily Living, (ADL) including transfers, ambulation, dressing, eating and hygiene. S/he was coded a 4 (four) on her/his BIMS (Brief Interview for Mental Status). S/he was coded as requiring extensive assistance with bathing. The resident was noted as continent of bladder. The only behavior noted was wandering. The most recent Quarterly MDS dated [DATE] coded the resident as requiring extensive assistance with walking and total assistance with dressing, eating, hygiene and bathing. S/he scored a 3 (three) on her/his BIMS. The resident was coded as incontinent of bladder. The resident was coded as having no behaviors. Further review of the Minimum Data Set (MDS) between 3/17/13 and 12/2/13 revealed: 8/5/13 Discharge Assessment, the resident was noted as having behaviors, [MEDICAL CONDITION], and delusions and coded for other behaviors not directed towards others. The resident was also coded as rejecting care. S/he was coded as requiring extensive assistance with bathing, hygiene, toilet use, with occasional bladder incontinence. 8/21/13 5 day assessment coded the resident with behaviors, [MEDICAL CONDITION], Delusions and behaviors not directed toward others. S/he was coded as requiring supervision with ambulation and locomotion. S/he was coded as requiring extensive assistance with dressing and hygiene with occasional bladder incontinence. 8/27/13 14 day assessment coded the resident as … | 2017-01-01 |
| 7782 | 7782 | WOODRUFF MANOR, LLC | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2012-10-31 | 159 | D | 0 | 1 | L6D511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on interviews and record review, the facility failed to provide 1 of 4 sampled interview-able residents a quarterly financial statement related to funds available in their personal trust account. (Resident #11) The findings included: The facility admitted Resident #11 into the facility with [DIAGNOSES REDACTED].#11 stated s/he needed some dental work done but s/he did not know how much money s/he had in his/her personal trust account. Resident #11 further showed Surveyor a brochure s/he had that addressed Patient's/Resident's Right that documented the facility's responsibility for managing the resident's personal funds account. Resident #11 stated s/he was not made aware of the amount of money s/he had available in his/her account at the facility. When Resident #11 was asked if s/he received a quarterly statement from the facility regarding his/her funds, the resident said no'. An interview on 10/30/12 at approximately 2:30 PM with the Business Office Manager (BOM) confirmed Resident #11 was not provided with a quarterly statement regarding his/her funds in the Resident Trust Fund Account. The BOM stated quarterly statements were sent to a family member but not the resident. | 2016-11-01 |
| 7783 | 7783 | WOODRUFF MANOR, LLC | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2012-10-31 | 241 | D | 0 | 1 | L6D511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On days of the survey, based on observations and interviews, the facility failed to ensure that 1 of 11 sampled residents and 1 random resident observed on the Unit 2 dining area were served with dignity during the dining experience. A Certified Nursing Aid (CNA) was standing and feeding Resident #9 and a CNA was observed standing and feeding a resident in the Unit 2 dining area. The findings included: The facility admitted Resident #9 with [DIAGNOSES REDACTED]. During evening meal observation on 10/29/12 at approximately 5:57 PM, CNA #1 was observed standing while feeding the resident. An interview and observation on 10/29/12 at approximately 6 PM with Licensed Practical Nurse #4 confirmed the findings. LPN #4 with Surveyor present, asked CNA #1 if there was a chair available to sit down face to face and feed the resident. CNA #1 was polite and stated I am short and I feed the resident standing up. LPN #4 acknowledged the CNA's statement and left the room. The CNA continued to stand and to feed the resident who was in bed. An interview on 10/30/12 at approximately 11:40 AM with LPN #5 revealed staff should be seated at eye level when feeding a resident. The LPN further that if it was care planned, it would be okay for staff to stand while feeding a resident. It was confirmed resident was not care planned for staff to stand while feeding Resident #9. On 10/29/12 at 11:45 AM, during observation of the lunch meal in the Unit 2 dining/day room, a random observation was noted of a Certified Nursing Assistant standing over a resident while feeding the resident who was seated in a gerichair. | 2016-11-01 |
| 7784 | 7784 | WOODRUFF MANOR, LLC | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2012-10-31 | 309 | E | 0 | 1 | L6D511 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey,based on record review, interview, and review of the facility policy entitled Pacemaker Policy and Procedure, there was no evidence of pacemaker checks for Residents # 4 and # 6 and no physician's order for pacemaker checks for Resident # 4. ( 2 of 2 sampled residents with pacemakers.) The findings included: The facility admitted Resident #4 with [DIAGNOSES REDACTED]. Record review on 10/19/12 revealed a [DIAGNOSES REDACTED]. No other documentation could be found in the medical record pertinent to the pacemaker. There were no physicians's orders related to doing pacemaker checks nor frequency of checks. There was no documentation or reports of any checks that might have been done A statement in the H&P (History and Physical) of 5/29/12 noted a pacemaker check had been done in the emergency room prior to the resident's admission to the nursing facility. However, no results of the check were noted There was a care plan dated 4/5/12 which documented Resident has [DIAGNOSES REDACTED]. There were no approaches pertaining to the pacemaker. LPN #1 (Licensed Practical Nurse) was interviewed about the pacemaker and stated the DON (Director of Nursing kept all the information on pacemakers. An interview with the DON on 10/29/12 at 3:30 PM revealed he/she had a list of residents with pacemakers with a list of dates under each resident's name. These were dates when checks were to be done. The DON stated the residents usually have the checks done when they go out to doctor's office visits or emergency room visits. He/she confirmed that the facility had no orders as to how often the checks should be done nor any information related to the pacemakers themselves. The sheet Pacemaker Checks noted Resident # 4 should have had checks done on 6/6/12 and 9/12/12. The facility had no documentation or reports showing the checks had been done. The facility admitted Resident #6 into the facility with a [DIAGNOSES REDACTED].#1 identified Resi… | 2016-11-01 |
| 7785 | 7785 | WOODRUFF MANOR, LLC | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2012-10-31 | 441 | D | 0 | 1 | L6D511 | On the days of the survey, based on observations and interview, the facility failed to ensure that staff used appropriate infection control practices while serving resident meals. Two staff members were observed touching resident food with their bare hands, The findings included: On 10/29/2012 at 11:45 AM, during meal service and set up of trays for the resident's lunch, LPN #7 was noted to hold a resident's sliced bread in his/her bare hand. CNA #2 was observed picking up a resident's roll with bare hands, opening the roll and then asking the resident if they wanted butter on it. When the resident stated no, the CNA laid the roll back onto the tray. On 10/30/12 at 2:10 PM, during an interview with CNA #2, the observations of the lunch meal on 10/29/12 were shared. CNA #2 stated that s/he was aware they were not supposed to touch resident food with their bare hands and that s/he should have worn gloves. | 2016-11-01 |
| 7912 | 7912 | WOODRUFF MANOR, LLC | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2013-10-15 | 323 | G | 1 | 0 | G8O611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the complaint investigation, based on record review and interview, the facility failed to ensure clear and concise guidance was provided to facility staff related to resident transfers. Resident # 1 was receiving multiple types of assistance with transfers that occurred both prior to and following identification of an injury to the right leg. On 8/29/13 the resident was admitted to the hospital with [REDACTED]. The findings included: The facility reported to the State Agency that Resident #1 had sustained a fracture of unknown origin and had been admitted to acute care for treatment. The resident was ultimately discharged at the family's request. On 10/15/13 record review revealed the facility investigation into the incident had concluded that the fracture occurred at the of the difficulties with the lift . and during repositioning . one of the fracture fragments protruded through the skin and resulted in an open wound. Resident #1 was admitted to the facility with [DIAGNOSES REDACTED]. On 8/24/13 a physician's order was written to change the method of transfer for the resident. The resident had previously been transferred using a stand-up lift. The new order stated: May use Marissa lift for transfers per protocol. This was documented as occurring at approximately 4:00 PM. When interviewing Licensed Practical Nurse (LPN) #2 who wrote this order, it was explained that the resident had exhibited some swelling and discoloration at the [PROCEDURE] site and it was concluded that the lift was the possible cause. The nurse stated the information was passed on in report and written in the 24 hour report. On 8/24/13, at approximately 6:30 PM, Certified Nursing Assistant (CNA) #1 was documented as having transferred the resident using the stand up lift per his/her own written statement. In addition to using the standup lift, the CNA violated facility policy and transferred the resident alone, (without assistance from additional staff memb… | 2016-10-01 |
| 2441 | 2441 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2017-07-05 | 250 | D | 1 | 0 | D4KD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interview, the facility failed to provide medically related social services interventions to 1 of 1 residents with attempted sexual abuse. Resident #4 was not followed by social services following an attempted sexual abuse by another resident. The findings included: The facility admitted resident #4 with [DIAGNOSES REDACTED]. Review of the medical record revealed Departmental Notes of 5/27/17. 5/27/17 At 4:42 PM a dietary aide reported to the nurse a male resident had his pants unzipped and pulling a lady in chair to him. The nurse went to the end of the hall and found the resident in a rock and go chair facing the male resident. The nurse could see the male resident with his right hand on the back of this resident's head and attempted to pull resident closer. The male resident had his full penis exposed and close to the resident's lips. The nurse called out to the resident and s/he removed his/her hand from the resident's head and backed away from the resident. This resident was turned around and directed back down the hall .This resident was examined with no new findings. Administrator, physician and Responsible Party (RP) notified. Further review revealed there were no Social Services Notes documented regarding the resident's psychosocial status following the encounter. On 7/5/17 at 2:40 PM, Social Services was interviewed by the surveyor. Social Services stated s/he was familiar with incident but was not at the facility when it occurred. It happened over the weekend and I was not here. No psychosocial interventions were done with Resident #4. I did psychosocial questions with residents that are interviewable but Resident #4 isn't. It's hard to get that information from her/him. There was no evidence the resident had been assessed/evaluated by Social Services | 2020-09-01 |
| 2442 | 2442 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2017-07-05 | 284 | D | 1 | 0 | D4KD11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interview, the facility failed to establish a discharge plan for 2 of 3 residents that were reviewed for discharge. Resident #1 and #3 were discharged from the facility and did not have discharge planning. The findings included: The facility admitted resident #1 with [DIAGNOSES REDACTED]. Review of the resident's plan of care did not contain a care plan for discharge. There was no plan of care for resident's need for extended long term care or for possible return to the community. The resident was discharged home with the family on 5/30/17 after an alleged incident at the facility. The facility admitted resident #3 with [DIAGNOSES REDACTED]. Review of the resident's plan of care revealed there was no plan for discharge. There was no plan in place for continued need for long term care or for return to the community. Social Services was interviewed on 7/5/17 at approximately 2:40 PM by the surveyor. S/he stated that both residents were not planned to be discharged but to continue to stay at the facility. I didn't give that notice of discharge, (Resident #1) the Administrator did. Resident #3 was not an actual planned discharge. The family just decided s/he wanted to take the resident home. I made a referral to home health for interim for Physical Therapy (PT) and Occupational Therapy (OT). | 2020-09-01 |
| 2443 | 2443 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2017-09-28 | 223 | G | 1 | 1 | N8CG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interview, the facility failed to ensure the safety and protection of its residents from harm, to include physical abuse as evidenced by Resident #[AGE]'s hospitalization following an incident with CNA #2 that resulted in a distal-humerus fracture, in addition to the nurse on duty neglecting to assess the resident's condition timely after being informed. Resident #[AGE] was one of three reviewed for reportable incidents. The findings included: Resident #[AGE] was admitted to the facility, with [DIAGNOSES REDACTED].On 07/19/17 , Resident #[AGE] was hospitalized following an incident with CNA #1 that resulted in a distal - humerus fracture, in addition the nurse on duty neglected to assess the resident's condition timely after being informed. According to the facility's investigation, CNA #2 was said to have been providing care to Resident #[AGE], on the last rounds of her/his shift. Per the CNA the resident was resisting care, at which time the resident's arms were pinned above her head by the CNA's forearm in an effort to complete the care that was being provided. The CNA informed the nurse on duty LPN #1, of the resident's complaints of pain, with a statement from the resident indicating the CNA as the individual who had caused the pain in her/his arm. Time lapse of approximately forty-five minutes, when the oncoming staff attempted to assist the resident to breakfast. The resident's arm was swollen and the resident was in pain. The oncoming nurse, for first shift, was notified and assessed the resident. The incident report on file was completed by the oncoming nurse. While reviewing the incident report and supporting documentation, it was revealed an injury to Resident #[AGE], described as prominent bony area on Rt (right) arm at approximately 7:15 a.m. The nurse who completed the form assessed the resident at that time and notified the nurse practitioner, who was on call at that time, the resident's family, the… | 2020-09-01 |
| 2444 | 2444 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2017-09-28 | 241 | D | 1 | 1 | N8CG11 | > Based on observations, interviews, and review of the facility's policy entitled Quality of Life -Dignity, the facility failed to maintain residents' dignity during the dining experience for 1 of 2 meals observed on one of three units. Staff failed to offer clothing protector before putting it on residents and failed to ask residents whether or not s/he wanted condiments on food items served during lunch meal. The facility also failed to knock prior to entering the shower room resulting on the exposure of a resident who was bathing. The findings included: Based on observation on 09/25/2017 at 7:13 AM, during the end of the initial tour the Surveyor asked the Certified Nursing Assistant (CNA) #1 to show the shower room for the 100 hall. CNA # 1 picked up a set of keys at the nurse station in the same hall and proceeded to unlock and open the door without knocking. This resulted in an exposure of a resident who was taking a shower during that time. During an interview with CNA #1 on 09/25/2017 at 7:21 the CNA was asked to explain the policy and procedure regarding entering a room. S/he stated you should knock before entering a room. S/he continued saying I would have knocked on the door if I knew someone was in it, but I did not know someone was there. On 09/25/2017 at 7:37 AM, CNA#1 was observed during breakfast putting clothing protector on residents without offering it or asking the resident if s/he would like it on. CNA proceeded to unwrap the bread and spread jelly on it, add sugar to coffee and unwrap and place the straw in the resident's drink without asking or communication to the residents what s/he was doing. At 7:54 AM CNA #1 was observed entering resident's rooms on multiple occasions without knocking or greeting the residents. S/he also failed to sanitize hands while handling resident's food or going in and out or their room. At 09/25/2017 7:57 AM CNA#1 was observed back in the dining area wearing a disposal glove on left hand only and continuing serving residents. | 2020-09-01 |
| 2445 | 2445 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2017-09-28 | 253 | D | 1 | 1 | N8CG11 | > Based on observations, interviews, and review of the facility policy entitled Cleaning and Disinfection of resident -Care Items and Equipment, the facility failed to provide sanitary and orderly living space for 6 of 6 sampled resident's rooms observed for environmental. This included unlabeled and uncovered urinal, bath and bed pans on the floor of shared bathroom of resident's room. The findings included: During Stage 1 of the survey on 09/25/2017 9:42 AM two unlabeled and uncovered bath pans were observed on the floor in the bathroom of room number 211B. At 9:58 of the same day an unlabeled and uncovered bed and bath pan and a urinal were observed on the floor in the bathroom of room number 205B. At approximately 10:16 AM of the same day, two unlabeled and uncovered bath pans were observed on the floor in the bathroom of the room number 216B During an environmental tour with the Director of Nursing and Maintenance personnel on 09/27/2017 at 11:01 AM the above findings were verified and two additional unlabeled and uncovered bed pans were observed on the floor in the bathroom of room number 204. The continued tour revealed one additional unlabeled and uncovered bed pan and a urinal on the floor in the bathroom of room number 207 and room number 208 and an uncovered and unlabeled bed and bath pan and urinal on the floor in the bathroom floor of room number 214. | 2020-09-01 |
| 2446 | 2446 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2017-09-28 | 441 | D | 1 | 1 | N8CG11 | > Based on observations and review of the facility's policy titled Handwashing/Hand Hygiene, the facility failed to ensure staff follow handwashing protocol during meal time for one of three dining observations. The findings included: Based on observation on 09/25/2017 at approximately 7:30 AM the Certified Nursing Assistant (CNA) #1 failed to practice hand hygiene during breakfast in one of three dining area observed. At 7:54 AM CNA #1 was observed handling resident's food and did not wash or sanitize hands before or after assisting residents with meals. | 2020-09-01 |
| 2447 | 2447 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2018-10-04 | 550 | D | 0 | 1 | 0Z3Q11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interview and review of the facility policy titled, Resident's Rights and Responsibilities, the facility failed to ensure Resident #55 was afforded complete privacy during wound care for 1 of 2 residents reviewed for Pressure Ulcers. The findings included: The facility admitted Resident #55 with [DIAGNOSES REDACTED]. An observation on 10/4/2018 at approximately 11:10 AM, during wound care of the sacrum revealed, Resident #55 in a semi-private room. LPN #2 knocked on the door, waited for the Resident #55 to answer, the resident did not answer, so the nurse asked if he/she could enter, and still no answer so he/she went to the bedside. The procedure was explained to the resident and this surveyor asked permission to observe the nurse doing the wound care and the resident stated. ok. The LPN and the assistant then washed their hands and applied gloves and proceeded with the wound care. Resident #55 was not afforded complete privacy at the time the wound care was started. The room door was not closed, the privacy curtain was not closed and the window blinds were not closed. LPN #2 continued with wound care. While the wound care was in progress, this surveyor observed, a male resident stop and look inside the room on his way down the hall. Other staff were up and down the hallway as well. An interview on 11/4/2018 at approximately 11:30 AM with LPN #2 confirmed that Resident #55 was not afforded complete privacy during wound care. Review on 11/4/2018 at approximately 1:20 PM of the facility policy titled, Resident's Rights and Responsibilities, states, Policy: To define the resident rights and responsibilities. Recognizing the basic rights of human beings for independence of expression, decision making, and action and concern for personal dignity and human relationships are always of great importance. Section, Bill of Rights, H. states, Each resident must be treated with respect and dignity and assured privacy during treatme… | 2020-09-01 |
| 2448 | 2448 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2018-10-04 | 580 | D | 0 | 1 | 0Z3Q11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interviews and review of the facility policy titled, Notification of Change in Resident's Condition, and, Fall Assessment and Fall Response, the facility failed to notify the physician for Resident #61 of a fall with a major injury for 1 of 3 residents reviewed for accidents. The findings included: The facility admitted Resident #61 with [DIAGNOSES REDACTED]. Review on 10/3/2018 at approximately 11:05 AM of the form titled, Resident Incident Report, dated 9/29/2018 revealed a fall for Resident #61. Resident #61 fell in the day room and obtained a head injury. A knot appeared with discoloration and ice was applied. Further review on 10/3/2018 at approximately 11:05 AM of the Resident Incident Report revealed the personal representative was notified but no documentation to ensure the physician for Resident #61 was called and notified of a fall with a head injury. During an interview on 10/4/2018 at approximately 3:00 PM with LPN (Licensed Practical Nurse) #3 stated, If a resident falls and receives an injury we are to call the resident's physician and let them know. Review on 10/4/2018 at approximately 2:20 PM of the facility policy titled, Notification of Change in Resident's Condition, states, Policy and Procedure: The facility must immediately inform the resident, consult with the resident's physician, and if known, notify consistent with his or her authority, the resident's legal representative, or an interested family member when there is: An accident involving the resident which results in injury and has the potential for requiring physician intervention. Review on 10/4/2018 at approximately 3:05 PM of the facility policy titled, Fall Assessment and Fall Response, states under, Fall Response, with injury and without injury, Notify the physician, | 2020-09-01 |
| 2449 | 2449 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2018-10-04 | 604 | D | 0 | 1 | 0Z3Q11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and review of the facility policy titled, Physical Restraints, the facility failed to ensure monitoring of a self release seat belt was completed and documented for Resident #58 for 1 of 1 resident reviewed for restraints. The findings included: The facility admitted Resident #58 with [DIAGNOSES REDACTED]. Review on 10/2/2018 at approximately 4:18 PM of the medical record for Resident #58 revealed an order which states, Rock n go when out of bed with self release alarm belt with black foam padding for poor safety awareness. Release every 2 hours and at meals or when one to one activity occurs, Check every 30 minutes. No documentation could be found in the medical record to ensure the restraint was monitored as ordered by the physician. Further review on 10/2/2018 at approximately 4:25 PM of the medical record for Resident #58 revealed a form titled, Restraint Release Record, dated 9/1/2018 through 9/30/2018 signed by CNAs (Certified Nursing Assistants) with sporadic documentation. No documentation could be found to ensure the restraint for Resident #58 was monitored for (MONTH) (YEAR) at all. During an interview on 10/4/2018 at approximately 1:42 PM with LPN (Licensed Practical Nurse) #2 he/she stated the CNAs monitor the restraints by documenting on the Restraint Release Record. Review on 10/4/2018 at approximately 2:00 PM of the facility policy titled, Physical Restraints, states, Responsibility: Licensed Nurse assigned to the resident is responsible for the quality of the care and services that are provided to the resident and documented compliance with the standards set forth in this document. Number 4. Care of the Resident in Restraints, states, The nurse shall monitor and reassess the resident in restraints every 30 minutes and release the restraint every two hours and document on the appropriate flow sheet: Type of Device or Restraint, Resident Response and Total hours released per shift. | 2020-09-01 |
| 2450 | 2450 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2018-10-04 | 686 | D | 0 | 1 | 0Z3Q11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and review of the facility policy titled, Dressing Changes, the facility failed to follow a procedure to promote healing and to prevent infection during wound care for Resident #55 for 1 of 2 residents reviewed for Pressure Ulcers. The findings included: The facility admitted Resident #55 with [DIAGNOSES REDACTED]. An observation on 10/4/2018 at approximately 11:10 AM of wound care for Resident #55 revealed LPN (Licensed Practical Nurse) #2 spraying the wound on the right buttocks with wound cleanser. LPN #2 then wiped in a circular motion around and around the inside and outside of the wound 3 times using the same gauze. An interview on 10/4/2018 at approximately 11:30 AM with LPN #2 confirmed the procedure that was used in the cleaning of the wound. Review on 10/4/2018 at approximately 12:15 PM of the facility policy titled, Dressing Changes, states. Policy: To prevent the spread of infection to residents and employees. | 2020-09-01 |
| 2451 | 2451 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2018-10-04 | 804 | E | 0 | 1 | 0Z3Q11 | Based on observation and interview, the facility failed to ensure that foods were served at an appetizing and/or appropriate temperature. The findings include: During an interview with Resident #3, s/he indicated the food served in the facility was cold when it should be hot, hard to eat and the coffee was cold for breakfast. A test tray was delivered to Unit 2 on 10/04/18 at breakfast and the findings were as follows: At 8:01 a.m. on 10/04/18, the last meal cart arrived on unit, at 8:06 a.m. the trays began being served, and at 8:15 a.m. the thermometer was calibrated by Dietary Worker #1 and temperatures were taken by the dietary worker. The eggs, grits and coffee were noted to be at acceptable, palatable temperatures. Yet, the sausage links showed an unacceptable temperature of 91 degrees and the juice showed an unacceptable temperature of 62 degrees. This information was conveyed to the Administrator, Director of Nursing and Certified Dietary Manager on 10/04/18 at 2:13 p.m. The findings were consistent with the resident's concern of food being served at less than appetizing temperatures. | 2020-09-01 |
| 2452 | 2452 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2018-10-04 | 812 | E | 0 | 1 | 0Z3Q11 | Based on observation and interview, the facility failed to ensure food was served in accordance with professional standards under sanitary conditions. Staff observed touching bread during the service of the breakfast meal on the 200 unit during 1 of 2 meal observations. In addition, based on observation and interview, the facility failed to ensure 3 of 3 ice scoopers in the main kitchen had proper receptacles with drainage to prevent collection of liquid. The findings included: An observation on 10/2/2018 at approximately 7:55 AM during the breakfast meal service revealed a staff member touching a residents bread to apply jelly. An interview on 10/4/2018 at approximately 8:10 AM with the RN (Registered Nurse) Unit Manager confirmed the observation. During the initial tour of the kitchen on 10/01/18 at 3:25 p.m., with the Certified Dietary Manager (CDM) it was noted 3 ice scoopers in a square plastic bucket. The bucket showed no evidence of abilities to drain excess liquid to prevent the potential for mildew and/or mold. On a follow up visit to the kitchen, the 3 ice scoopers were still noted to be in the plastic bucket on 10/04/18 at 11:16 a.m., again this concern was conveyed to the CDM and then to the Administrator. | 2020-09-01 |
| 2453 | 2453 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2018-10-04 | 880 | D | 0 | 1 | 0Z3Q11 | Based on observations, interview and review of the facility policy titled, Linen, and, Infection Control Standard Precautions Policy, the facility failed to ensure soiled linen was bagged at point of use prior to brining it to the soiled utility room on 2 of 2 units and placing it in the bins, The facility further failed to apply PPE (Personal Protective Equipment) prior to sorting and loading the washers with soiled linen in 1 of 1 laundry room. The findings included: An observation on 10/4/2018 at approximately 9:05 AM, during soiled linen pick up on the 100 and 200 units, revealed soiled linen not bagged and placed in the bins in the soiled utility rooms. During an interview on 10/4/2018 at approximately 9:10 AM with laundry worker #1 verified the soiled linen was not bagged prior to placing it in the bins in the soiled utility room. Laundry worker #1 stated, Sometimes they bag it and sometimes they don't. An interview on 10/4/2018 at approximately 9:30 PM with the Housekeeping Supervisor confirmed that the linen is not always in plastic bags and then put in the bins in the soiled utility room. It should be bagged but sometimes it is not. Review on 10/4/2018 at approximately 9:40 AM of the facility policy titled, Linen, the policy states, Clean linen and soiled linen supplies shall be handled in a manner that reduces risk for microbial contamination and disease exposure. Under Procedure: 2.6 states, Soiled linen shall be bagged at the point of use in approved linen bags. An observation on 10/4/2018 at approximately 9:45 AM during the sorting and loading of the clothes washers laundry worker #1 was observed without PPE (gown) removing soiled linen and resident personal clothes from the plastic bags, and with gloved hands) and placing it in the clothes washer. During an interview on 10/4/2018 at approximately 9:46 AM with Laundry Worker #1 stated, he/she was informed that he/she did not need to wear a gown as long as the soiled items did not touch his/her uniform. Review on 10/4/2018 at approximately 10:30 AM of… | 2020-09-01 |
| 2454 | 2454 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2018-10-04 | 908 | E | 0 | 1 | 0Z3Q11 | Based on observation, interviews and review of the facility policy titled, To Avoid Creating a Fire, Spontaneous Combustion or Explosion Hazard, the facility failed to ensure a large build up of lint was removed from the upper insides and on the wiring of 1 of 3 clothes dryers. The findings included: An observation on 10/4/2018 at approximately 8:30 AM revealed 1 of 3 clothes dryers with a large build up of lint on the upper sides above the lint basket and on the wiring. An interview on 10/4/2018 at approximately 8:30 AM with the Housekeeping Director confirmed the large build of lint on the upper sides and wiring in 1 of 3 clothes dryers. An interview on 10/4/2018 at approximately 8:45 AM with the Maintenance Director confirmed the build up of lint in the clothes dryers and stated, I keep a log of the lint removal and they were last vacuumed out on 9/20/2018 and they are now due again for cleaning. The Maintenance Director stated that the lint is removed monthly. Review on 10/4/2018 at approximately 9:20 AM of the facility policy titled, To Avoid Creating a Fire, Spontaneous Combustion or Explosion Hazard. states, Keep appliance area clean and free from combustible materials, and Always clean the lint filter daily. A layer of lint in the filter reduces drying efficiency and prolongs drying time. | 2020-09-01 |
| 2455 | 2455 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2019-12-29 | 600 | D | 0 | 1 | U35N11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide a cognitively impaired resident with adequate supervision to prevent resident to resident altercations. This involved one out of two wandering residents in the sample (#9). Resident #9 experienced nine documented incidents of wandering into other residents' rooms; four incidents resulted in resident to resident altercations. Findings include: Review of the clinical record revealed an admission history form dated 04/08/19. The admission history documented Resident #9 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The quarterly minimum data set (MDS) assessment dated [DATE] documented the resident had a Brief Interview for Mental Status (BIMS) score of 3 out of 15, significant cognitive impairment, and required only supervision for ambulation. Resident #9 was observed ambulating without any assistive device. Resident #9 had a plan of care (P[NAME]) dated 05/20/19 that documented she had a history of [REDACTED].#9 as needed.' On 12/27/19 at 10:34 AM, Resident #9 was initially observed ambulating in the hallways of the nursing home. She was dressed and ambulating without any assistive device in and out of the day room and up and down the hallways. Resident #9 was observed being redirected by a staff member out of another resident's room which was located across the hallway from Resident #9's room. Review of the clinical record on 12/28/19 at 1:07 PM revealed Resident #9 had been involved in four resident-to-resident altercations; all occurred in the other residents' rooms. The altercations were documented on a facility incident report as follows: - On 06/29/19 at 3:00 PM, Housekeeper #27 witnessed Resident #9 hit her roommate. - On 08/08/19 at 6:15 AM, Resident #9 wandered into room [ROOM NUMBER]. Resident #21 resided in room [ROOM NUMBER]. Resident #21 yelled for Resident #9 to leave her room. Resident #9 stuck Resident #21 with a shoe on the kn… | 2020-09-01 |
| 2456 | 2456 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2019-12-29 | 609 | D | 0 | 1 | U35N11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to report allegations of abuse. This involved one out of two wandering residents in the sample (#9). Resident #9 experienced nine documented incidents of wandering into other residents' rooms; four incidents resulted in resident to resident altercations. Findings include: Review of the clinical record revealed an admission history form dated 04/08/19. The admission history documented Resident #9 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The quarterly minimum data set (MDS) assessment dated [DATE] documented the resident had a Brief Interview for Mental Status (BIMS) score of 3 out of 15, significant cognitive impairment, and required only supervision for ambulation. Resident #9 was observed ambulating without any assistive device. Resident #9 had a plan of care (P[NAME]) dated 05/20/19 that documented she had a history of [REDACTED].#9 as needed.' On 12/27/19 at 10:34 AM, Resident #9 was initially observed ambulating in the hallways of the nursing home. She was dressed and ambulating without any assistive device in and out of the day room and up and down the hallways. Resident #9 was observed being redirected by a staff member out of another resident's room which was located across the hallway from Resident #9's room. Review of the clinical record on 12/28/19 at 1:07 PM revealed Resident #9 had been involved in four resident-to-resident altercations; all occurred in the other residents' rooms. The altercations were dated 06/29/19 at 3:00 PM, 08/08/19 at 6:15 AM, 08/26/19 at 11:00 PM, and 09/02/19 at 8:45 PM. The facility documented these as incidents. They were not reported and investigated as alleged allegations of abuse. The altercations were documented on a facility incident report as follows: - On 06/29/19 at 3:00 PM, Housekeeper #27 witnessed Resident #9 hit her roommate. - On 08/08/19 at 6:15 AM, Resident #9 wandered into room [ROOM NUMBER]. … | 2020-09-01 |
| 2457 | 2457 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2019-12-29 | 610 | D | 0 | 1 | U35N11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to investigate allegations of alleged abuse. This involved one out of two wandering residents in the sample (#9). Resident #9 experienced nine documented incidents of wandering into other residents' rooms; four incidents resulted in resident to resident altercations. Findings include: Review of the clinical record revealed an admission history form dated 04/08/19. The admission history documented Resident #9 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The quarterly minimum data set (MDS) assessment dated [DATE] documented the resident had a Brief Interview for Mental Status (BIMS) score of 3 out of 15, significant cognitive impairment, and required only supervision for ambulation. Resident #9 was observed ambulating without any assistive device. Resident #9 had a plan of care (P[NAME]) dated 05/20/19 that documented she had a history of [REDACTED].#9 as needed.' On 12/27/19 at 10:34 AM, Resident #9 was initially observed ambulating in the hallways of the nursing home. She was dressed and ambulating without any assistive device in and out of the day room and up and down the hallways. Resident #9 was observed being redirected by a staff member out of another resident's room which was located across the hallway from Resident #9's room. Review of the clinical record on 12/28/19 at 1:07 PM revealed Resident #9 had been involved in four resident-to-resident altercations; all occurred in the other residents' rooms. The altercations were dated 06/29/19 at 3:00 PM, 08/08/19 at 6:15 AM, 08/26/19 at 11:00 PM, and 09/02/19 at 8:45 PM. The facility documented these as incidents. They were not reported and investigated as alleged allegations of abuse. The altercations were documented on a facility incident report as follows: - On 06/29/19 at 3:00 PM, Housekeeper #27 witnessed Resident #9 hit her roommate. - On 08/08/19 at 6:15 AM, Resident #9 wandered into room [R… | 2020-09-01 |
| 4395 | 4395 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2016-09-16 | 157 | D | 0 | 1 | K44M11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure the responsible party was notified following a significant medication change for 1 out of 5 sampled residents reviewed for unnecessary medications. Resident #50's responsible party was not notified of a change in medication regimen. The findings included: Resident #50 was admitted to the facility with [DIAGNOSES REDACTED]. Review of Resident #50's record revealed s/he started on [MEDICATION NAME] on 09/02/16. The order was written on a Physician's Telephone Order. The order included an area to record notification of the Responsible Party, and that section was left blank. Review of Resident #50's nursing notes revealed no documentation in the notes that the Responsible Party was notified of the start of [MEDICATION NAME] for Resident #50. In an interview on 09/16/16 at 10:30 AM, Registered Nurse #1 stated s/he had taken the order and did not document notification of the Responsible Party related to Resident #50 starting [MEDICATION NAME]. | 2020-02-01 |
| 4396 | 4396 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2016-09-16 | 241 | D | 0 | 1 | K44M11 | Based on observation and interview, the facility failed to promote dignity during dining in 1 of 3 observed dining rooms . The findings included: Observation in the 200 dining area on 09/13/16 at 11:31 AM revealed a Certified Nursing Assistant (CNA) placing adult clothing protectors on residents without asking their permission. Observation at 11:49 AM revealed the lunch trays arrived in the dining area. There were 9 total residents in the room and their lunches were left on trays and not transferred to the table. Observation in the 200 dining area on 09/15/16 at 11:51 AM revealed lunches were left on trays, without transferring plates and bowls to the table, for 8 residents. In an interview on 09/16/16 at 8:15 AM, the facility administrator stated food should have been transferred from trays and onto the table for those in the dining areas. | 2020-02-01 |
| 4397 | 4397 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2016-09-16 | 242 | D | 0 | 1 | K44M11 | Based on observation and interview, the facility failed to accommodate choices related to dining for 1 out of 3 residents reviewed for Nutrition. Resident #50 was not allowed to dine in the dining area. The findings included: Observation in the 200 dining area on 09/15/16 at 11:50 AM revealed lunch service was starting. At 12:20 PM, Resident #50 wheeled his/her own wheelchair into the dining area for lunch. There were no spaces available for dining, and a Certified Nursing Assistant (CNA) wheeled Resident #50 back out of the room. The CNA told Resident #50 s/he would eat later when there was room. At 12:22 PM, Resident #50 again wheeled his/her wheelchair into the dining room. A CNA removed Resident #50 from the dining area and took the resident to his/her room. Observation at 12:35 PM revealed Resident #50 was eating lunch from an over bed table in his/her room. In an interview on 09/15/16 at 12:25 PM, Licensed Practical Nurse (LPN) #1 revealed it was preferable for Resident #50 to eat in the dining area so s/he could be monitored more closely by staff. In an interview on 09/16/16 at 8:15 AM, the Facility Administrator confirmed Resident #50's preference to eat in the dining area should have been accommodated and the resident should not have been taken to his/her room to dine. | 2020-02-01 |
| 4398 | 4398 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2016-09-16 | 250 | D | 0 | 1 | K44M11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record reviews and interviews, the facility failed to address the needs of 1 of 3 residents reviewed for nutrition. There was no evidence of social service intervention for Resident #89 related to ill fitting dentures. The findings included: The facility admitted Resident #89 on 3-30-2016 with [DIAGNOSES REDACTED]. Resident #89 also had a history of [REDACTED]. Resident #89 continued to show a pattern of weight loss in the facility. Observation of Resident #89 on 9-16-16 at 8:30 am revealed s/he had eaten approximately 2/3 of the breakfast meal. When asked if her/his dentures were in, the resident reported they were not and stated s/he would like something done with the dentures because they did not fit any more. On 9-15-2016 at 10 am, review of the 3-31-16 Dietary Initial Assessment revealed that the Certified Dietary Manager (CDM) was aware that Resident #89 had ill fitting dentures. Review of the 4-6-16 Minimum Data Set (MDS) noted that the resident was coded as having broken or loosely fitting dentures in Section [MI] Further record review revealed no evidence of a dental referral or of the resident having been seen by the dentist. During an Interview on 9-15-16 at 10:30 am, the CDM stated s/he had notified the admitting nurse of the denture concern but s/he did not know if anyone else had been notified. Interview with Social Services on 9-15-16 at 3 PM revealed that s/he was unaware of the ill fitting dentures and that no interventions had been initiated. S/he reported that either the nurse or the Dietary Manager should notify Social Services about these issues. During an interview on 9-16-16 at 3:30 pm, the Administrator stated that the facility had no contract/agreement for provision of dental services. | 2020-02-01 |
| 4399 | 4399 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2016-09-16 | 253 | E | 0 | 1 | K44M11 | Based on observation and interview, the facility failed to maintain doors in good repair on 2 out of 2 units observed. The findings included: Observation in the facility on 09/16/16 revealed doors in rooms 105, 204, 205, 206, 210, 211, and 212 had scars and deep grooves on the bottoms, with missing and peeling paint and stain. In an interview on 09/16/16 starting at 11:00 AM, the facility maintenance director confirmed the presence of the damaged doors and revealed there were no current work orders in place to repair or replace the doors. | 2020-02-01 |
| 4400 | 4400 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2016-09-16 | 272 | D | 0 | 1 | K44M11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to complete the Urinary Assessment for Resident #96. 1 of 1 reviewed for urinary incontinence. The findings included: The facility admitted resident #96 with a [DIAGNOSES REDACTED]. Record review on 09/16/2016 at approximately 9:20AM revealed no Care Area Triggers (CATs) and no Care Area Assessments (CATs) for the Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 3/23/16. During an interview with the MDS Coordinator on 9/16/16 at approximately 10:35 when asked if the CATs and CAAs were missing from the MDS, s/he stated, I am new to the position and did not know I was supposed to do them. S/he also stated there have been no CATs or CAAs done prior to (MONTH) for almost a year. | 2020-02-01 |
| 4401 | 4401 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2016-09-16 | 278 | D | 0 | 1 | K44M11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, record review, and review of the Resident Assessment Instrument (RAI) Manual, Version 1.13, (MONTH) (YEAR), the facility failed to accurately code Sections C and D on the Minimum Data Set (MDS) assessments for two of three sampled residents reviewed for Minimum Data Set (MDS) accuracy related to conduction of interviews (Residents #7 and #30). The findings included: The facility admitted Resident #30 with [DIAGNOSES REDACTED]. Observation of Resident #30 on 9-14-16 at 3 PM revealed the resident in bed, talking to him/herself with un-intelligible words. Record Review on 9-15-16 at 11:30 am revealed that the 8-12-16 Quarterly Minimum Data Set (MDS) Section B was coded that Resident #30 had unclear speech, was sometimes understood and sometimes had the ability to understand others. Under Section C, Cognitive Patterns and Section D Mood, the Brief Interview for Mental Status (BIMS) and the resident mood interview were not attempted/conducted because the resident was noted as rarely/never understood. Staff interviews were conducted on Resident #30 for the 8-12-2016 assessment. The facility admitted Resident #7 with [DIAGNOSES REDACTED]. Resident #7 had MDS assessments completed for the dates of 6-10-2016 and 9-2-2016. In Section B, the resident was coded as having no speech, rarely/never understood and rarely/never understands. The BIMS and PHQ-9 (mood) interviews were conducted in Section C and D on both the 6-10-16 quarterly and 9-2-16 annual assessments, instead of the staff interviews. Staff interviews were conducted in Sections F (daily routines/activities) and J (pain) by the MDS Coordinator. During an interview on 9-15-16 at 5:45 pm, Social Services stated that s/he completed Sections C and D of the assessments. S/he reported asking residents yes/no questions to determine speech levels as well as cognition and mood (Sections C and D). When asked if the MDS Coordinator and Social Services completed the inte… | 2020-02-01 |
| 4402 | 4402 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2016-09-16 | 279 | D | 0 | 1 | K44M11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to develop a care plan for urinary incontinence for Resident #96. 1 of 1 resident reviewed for urinary incontinence. In addition, the facility failed to develop a care plan for contractures for one of two sampled residents reviewed for range of motion (Resident #7). The findings included: The facility admitted resident #96 with [DIAGNOSES REDACTED]. Record review on 09/16/2016 at 9:00AM revealed no care plan for Urinary Incontinence although the Minimum Data Set (MDS) Assessment Reference Date (ARD) dated 06/17/2016, Section H Bladder and Bowel H0500: states a Bowel and Bladder Program being used. During an interview with the MDS Coordinator on 9/16/16 at 10:25 when asked if a care plan for Urinary Incontinence had been devised, s/he stated, no, although it was captured on the MDS, the care plan was not updated. The facility admitted Resident #7 with [DIAGNOSES REDACTED]. Multiple observations (on 9-13-16 at 9 am and 4 pm, on 9-14-16 at 8:50 am, and on 9-15-16 at 1 pm) revealed Resident #7 in bed with both legs flexed at hips and knees. No splints or pillows/positioners were noted in place to prevent contractures from worsening. During an interview on 9-13-16 at 11:15 pm, Registered Nurse #2 stated that the resident had contractures in both legs and that no splints or range of motion (ROM) services were being provided. Review of the MDS (Minimum Data Set) Section G on 9-14-16 at 11 am revealed that the resident was coded as having functional impairment of range of motion (ROM) in both lower extremities. Section O noted no restorative services for ROM. Record review on 9-14-16 at 11:30 am revealed that Resident #7's 9-2-2016 Care Plan had no problem listed related to contractures or interventions to prevent further decline in ROM and to prevent contractures from worsening. During an interview on 9-15-16 at 1:27 pm, the MDS Coordinator and Corporate MDS liasion stated it would be appropr… | 2020-02-01 |
| 4403 | 4403 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2016-09-16 | 318 | D | 0 | 1 | K44M11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure that one of two residents reviewed for range of motion (ROM) and existing contractures was provided services to prevent further decline. There was no evidence of provision of care to prevent further decline in ROM for Resident #7. The findings included: The facility admitted Resident #7 with [DIAGNOSES REDACTED]. Multiple observations (on 9-13-16 at 9 am and 4 pm, on 9-14-16 at 8:50 am, and on 9-15-16 at 1 pm) revealed Resident #7 in bed with both legs flexed at hips and knees. No splints or pillows/positioners were noted in place to prevent contractures from worsening. During an interview on 9-13-16 at 11:15 pm, Registered Nurse #2 stated that the resident had contractures in both legs and that no splints or range of motion (ROM) services were being provided. Review of the MDS (Minimum Data Set) Section G on 9-14-16 at 11 am revealed that the resident was coded as having functional impairment of range of motion (ROM) in both lower extremities. Section O noted no restorative services for ROM. Record review on 9-14-16 at 11:30 am revealed that Resident #7's 9-2-2016 Care Plan had no problem listed related to contractures or interventions to prevent further decline in ROM and to prevent contractures from worsening. Record review on 9-14-16 at 11:15 am revealed no reference to provision of any services to prevent further decline in ROM, to prevent contractures from worsening. During an interview on 9-15-16 at 1:27 pm, the MDS Coordinator and Corporate MDS liasion stated it would be appropriate to care plan the resident's contractures. | 2020-02-01 |
| 4404 | 4404 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2016-09-16 | 325 | D | 0 | 1 | K44M11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to identify and provide interventions to address weight loss for one of 3 sampled residents reviewed for nutrition. No interventions were noted for Resident #89 who had documentation of significant weight loss prior to and after admission to the facility. The findings included: The facility admitted Resident #89 on 3-30-2016 with [DIAGNOSES REDACTED]. Record review on 9-14-16 at 12:30 pm revealed a 3-31-16 Dietary Assessment completed by the Certified Dietary Manager (CDM). The assessment noted that Resident #89 had a history of [REDACTED]. Review of Weight Records on 9-14-16 revealed the following: -March 30, (YEAR) = weight 100 lbs. -April 7, (YEAR) weight = 95 lbs (This represents a 5% weight loss since admission.) -April 11, (YEAR) weight = 93 (This represents a 7% weight loss since admission.) -April 13, (YEAR) weight = 94.6 lbs (This represents at 5.4% weight loss since admission.) -April 27,2016 weight = 94 lbs.(This represents a 6% weight loss since admission.) There was no evidence in the medical record that interventions had been put in place to prevent further weight loss. There was no evidence in the record that Resident #7 had been evaluated/assessed by a Registered Dietitian for weight loss. Review of the Minimum Data Sets (MDS) revealed that the weight loss had not been coded in Section K on the 4-6-16, 4-13-16, or 4-28-16 assessments. Review of the 4-6-16 Care Plan revealed that the resident was at Nutritional Risk but did not address actual weight loss. During an interview on 9-15-16 at 4 pm, the CDM stated that s/he did not code the weight loss on the MDS due to the fact that the resident was receiving diuretics. When asked about a referral to the Registered Dietitian (RD) to address the weight loss, the CDM stated that s/he could not recall if a referral had been made. During an interview on 9-16-16 at 9 am, the RD stated that s/he routinely got referrals from the C… | 2020-02-01 |
| 4405 | 4405 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2016-09-16 | 356 | C | 0 | 1 | K44M11 | Based on observation, record review, and interview, the facility failed to post daily nurse staffing data at the beginning of each shift as required and failed to retain daily nurse staffing data for 18 months as required. The findings included: Observation on 9/14/16 at approximately 10:00 AM revealed the daily nurse staffing data was posted on the bulletin board near the main dining room. Further review of the form revealed staffing information was posted for all shifts at that time. Observation of the form revealed the same finding on 9/15/16 at approximately 9:00 AM. The surveyor requested past copies of the daily nurse staffing data. On 9/15/16 at approximately 3:00 PM, the Administrator and office staff informed the surveyor that these forms were unavailable, and that they were unaware of the requirement to retain copies of the staff posting. | 2020-02-01 |
| 4406 | 4406 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2016-09-16 | 371 | E | 0 | 1 | K44M11 | Based on observation and interview, the facility failed to distribute and serve food under sanitary conditions for two of two meals observed on two of two units. Trays were transported down halls without food items being covered. The findings included: Observation of the serving of the lunch meal on 9-13-16 revealed that bowls of fruit and salad were not covered on trays being delivered on open carts from the main dining room to residents being served on the two units. Food trays were also brought in closed carts to both units for routine room service and service to the day/dining areas at each nursing station. The carts were placed at the nursing stations, trays removed and carried down the halls for delivery to the residents' rooms with uncovered bowls of food items. On 9-14-16 during the noon meal, the same procedures were followed by staff and desserts were served uncovered on the trays. During an interview on 9-15-16 at 9:30 am, the Certified Dietary Manger stated s/he thought the side items did not need covering. S/he said that nursing staff was supposed to stop the cart just outside the residents' doors and take the trays directly from the delivery truck to the resident. | 2020-02-01 |
| 5606 | 5606 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2015-06-04 | 157 | E | 0 | 1 | 02VR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to notify the physician of behaviors for Resident #5 and #14, 2 of 9 residents reviewed for behaviors. The facility failed to notify the physician that Resident #14 was refusing Fingerstick Blood Sugars (FSBS) and/or Sliding Scale Insulin (SSI) and failed to notify the physician of Resident #5's continued behaviors that included refusing care, screaming/yelling and inappropriate sexual behavior. The findings included: The facility admitted Resident #5 with [DIAGNOSES REDACTED]. On 6/3/15 at 11:55 AM, record review revealed a Psychiatric Progress Note dated 12/18/15 that stated Pt (patient) is still having sexual interactions (with) another pt. who is also very pursuant of that activity and stated that the resident's medication was adjusted. Review of the Psychoactive Drug Weekly Evaluation forms from 12/19/14 to 5/22/15 revealed the resident was documented as exhibiting cursing, arguing, inappropriate sexual behavior, manipulative/ demanding behavior, resisting/refusing care, screaming/ yelling, accusing others, and aggressive behaviors that varied from week to week. There was no documentation that the physician had been notified of any of the continued behaviors. Review of the Interdisciplinary Progress Notes revealed the resident was reviewed for devices and transfers on 4/27/15 but not for behaviors. The notes further indicated the resident was reviewed for picking at several other residents, poking them (with) his fingers and becoming verbally aggressive toward another resident on 5/27/15 and a new intervention was implemented that the resident would eat meals in the unit day room instead of the main dining room; there was no documentation the physician was notified. During an interview on 6/3/15 at 3:25 PM, Licensed Practical Nurse (LPN) #4 confirmed the documentation of the continued behaviors including sexually inappropriate behaviors, and that there was no documentation in th… | 2018-11-01 |
| 5607 | 5607 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2015-06-04 | 167 | C | 0 | 1 | 02VR11 | Based on observations and interviews the facility failed to make the most recent survey results accessible and failed to post signs for location of results on 2 of 2 units. The findings include: On 6/4/15 at approximately 8:30 AM the most recent survey results were found on a side table in the entrance lobby and the door from the two resident units to the lobby was locked and could only be opened with a key by a member of the facility staff. On 6/4/15 at approximately 8:35 AM no signs were found posted for location of survey results on the two nursing units. On 6/4/15 at approximately 8:40 AM the person responsible for Medical Records and the Administrator stated that the survey results were kept in the lobby and the Administrator stated that survey results were kept near the exit door to the outside smoking area and that there should be a sign on each nursing unit. On 6/4/15 at approximately 8:45 AM the person responsible for Medical Records discovered that there were no survey results near the exit door to the smoking area and was unable to locate a sign on either of the two nursing units. | 2018-11-01 |
| 5608 | 5608 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2015-06-04 | 226 | D | 0 | 1 | 02VR11 | Based on record reviews, interviews and review of the facility's policy entitled Background Screening Investigations, the facility failed to conduct a criminal background check for 3 of 22 employees reviewed for criminal background checks. The findings included: On 6/3/15, during review of the employee files for the extended survey, it was noted that 3 of 22 Certified Nursing Assistant (CNA), Registered Nurse (RN) and/or Licensed Practical Nurse (LPN) criminal background checks were not conducted prior to the employee's hire date. Review of the facility's policy entitled Background Screening Investigations indicated in . Policy Interpretation and Implementation . 1. The Personnel Director/Human Resources Director, or other designee, will conduct employment background checks and criminal conviction checks (including fingerprinting as may be required by state law) on persons making application for employment with this facility. Such investigation will be indicated within two days of employment or offer of employment . The findings were confirmed during an interview with the Human Resources staff. | 2018-11-01 |
| 5609 | 5609 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2015-06-04 | 253 | E | 0 | 1 | 02VR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility had multiple rooms with loose/torn baseboards, rust and/or significant scarring of paint on bathroom door frames, soiled/rusted over toilet seats and expired food items in a resident room. The concerns were noted in 10 of 23 rooms observed on Unit 1. In addition the facility failed to maintain a clean comfortable area for resident's to dine and watch television on Unit 1. The findings included: On [DATE] at approximately 9:45 AM, during tour of the facility, Room 116 was noted to have baseboard peeling from the wall near the bathroom and in the bathroom. The sink in the bathroom was pulling away from the wall and was noted to have a thick black substance along the crack between the wall and the sink. On [DATE] at approximately 10:20 AM, Rooms 114, 115, 116 and 120 were noted to have paint missing along the bathroom door frames and rusted areas where paint was missing on both sides of the doorway approximately 6 inches up the frame from the floor. Peeling wall paper was noted on the wall to the left of the sink in room 115. During initial tour of the facility on [DATE], multiple environmental concerns were identified on the 100 Unit: Room 100 bathroom - Rust around the bottom of the toilet and on the bolts of the raised over-toilet seat, missing paint and rust on the bathroom door frame. Room 101 bathroom - Rust around the bottom of the toilet, toilet seat scratched with brown stain, and missing paint and rust on the bathroom door frame. Room 102 B - Expired food items on the bedside table. Room 103 - Soiled arms on the raised over-toilet seat, missing paint and rust on the bathroom door frame with a hole in the metal at the bottom of the frame. Room 104 bathroom - Rusty uncovered bolts on the toilet, torn arm on the raised over-toilet seat, and missing paint and rust on the bathroom door frame. Room 108 - Missing paint and rust on the bathroom door frame, loose baseboard by the door. On [DATE… | 2018-11-01 |
| 5610 | 5610 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2015-06-04 | 280 | D | 0 | 1 | 02VR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to review and/or revise the care plan to include 15 minute checks for Resident #5, 1 of 9 residents reviewed, to monitor for behaviors. The finding included: The facility admitted Resident #5 with [DIAGNOSES REDACTED]. On 6/3/15 at 11:55 AM, review of the Psychoactive Drug Weekly Evaluation forms from 12/19/14 to 5/22/15 revealed the resident was documented as exhibiting cursing, arguing, inappropriate sexual behavior, manipulative/ demanding behavior, resisting/refusing care, screaming/ yelling, accusing others, and aggressive behaviors that varied from week to week. Review of the care plan revealed a care plan for Behaviors with interventions including Observe for changes in mood and behavior. Medications and psych (psychiatric) consults as ordered. Redirect resident when approaching other residents. Attempt to engage in activities of interest to redirect from behaviors. During an interview on 6/3/15 at 3:25 PM, Licensed Practical Nurse (LPN) #4 confirmed the documentation and stated that the resident was on q (every) 15 minute checks. The LPN further confirmed the care plan had not been updated to include the intervention . | 2018-11-01 |
| 5611 | 5611 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2015-06-04 | 282 | D | 0 | 1 | 02VR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation and resident interview, the facility failed to provide care in accordance with the written plan of care for behaviors for Resident #5, 1 of 9 residents reviewed for behaviors. The findings included: The facility admitted Resident #5 with [DIAGNOSES REDACTED]. On 6/3/15 at 11:55 AM, record review revealed a Psychiatric Progress Note dated 12/18/15 that stated Pt (patient) is still having sexual interactions (with) another pt. who is also very pursuant of that activity and stated that the resident's medication was adjusted. Review of the Psychoactive Drug Weekly Evaluation forms from 12/19/14 to 5/22/15 revealed the resident was documented as exhibiting cursing, arguing, inappropriate sexual behavior, manipulative/ demanding behavior, resisting/refusing care, screaming/ yelling, accusing others, and aggressive behaviors that varied from week to week. Review of the care plan revealed a care plan for Behaviors with interventions including Observe for changes in mood and behavior. Medications and psych (psychiatric) consults as ordered. Redirect resident when approaching other residents. Attempt to engage in activities of interest to redirect from behaviors. Upon entering the room for an Individual Interview with Resident #5 on 6/4/15 at approximately 10:10 AM, a staff member was observed sitting in the resident's room watching the television. The resident was laying on the bed. When asked what activities the resident participated in, the resident stated the facility ain't got no activities here, not that I like. When asked what kind of activities the resident enjoyed, Resident #5 stated I like card games and checkers and stated that there were no residents that were able or knew how to play. When questioned about the staff the resident stated Something must have happened, I got somebody baby-sitting me now. The sitter stated that the resident knew why s/he was there. The sitter was not observed engaging the res… | 2018-11-01 |
| 5612 | 5612 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2015-06-04 | 323 | L | 0 | 1 | 02VR11 | Based on observations, record reviews and interviews the facility failed to assure safe water temperatures for 13 of 13 resident bathrooms on Unit 2 (Hall 200). The Maintenance Director failed to have adequate knowledge for checking temperatures and calibrating thermometers and there was no scheduled monitoring of water temperatures. The findings include: On 6/2/15 at approximately 9:00 AM during initial tour of the facility water temperatures were checked by hand in thirteen resident bathrooms on Unit 2 and observed to be too hot. On 6/2/15 at approximately 9:30 AM Surveyor Team thermometers were used to check all facility bathrooms. Thirteen resident bathrooms on Unit 2 were found to have hot water temperatures of approximately 121-124 degrees F (Fahrenheit). On 6/2/15 at approximately 9:55 AM the Maintenance Director was asked to provide a water temperature log and to take water temperatures for the Unit 2 resident bathrooms. He/she stated that no log was kept and obtained a(NAME)stick thermometer from the kitchen. When asked about calibration he/she stated that the thermometer had been calibrated yesterday. The Surveyor asked for the thermometer to be calibrated again and the Maintenance Director took the thermometer to the kitchen and asked the Dietary Manager to calibrate. On 6/2/15 at approximately 10:10 AM the Maintenance Director used the kitchen thermometer calibrated by the Dietary Manager to check bathroom water temperatures on Unit 2. Water temperatures were check in bathrooms for room 201/203, 204/206, 209, 211/213, 216 and 215/217. The results obtained by the Maintenance Director were between approximately 100-110 degrees F. The Maintenance Director demonstrated considerable variability in technique when taking temperatures and stated several times that the water sure feels a lot hotter than this. The thermometer was held under the hot water stream at varying angles and the entire temperature sensitive portion of the thermometer was not exposed to the water. The Surveyor temperature reading taken a… | 2018-11-01 |
| 5613 | 5613 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2015-06-04 | 325 | E | 0 | 1 | 02VR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to maintain acceptable parameters of nutritional status by providing nutritional supplements as recommended for Resident #3, 1 of 3 residents reviewed for significant weight change. The findings included: The facility admitted Resident #3 with [DIAGNOSES REDACTED]. On 6/4/15 at 2:02 PM, record review revealed a Telephone Order dated 5/12/15 for a Dietary Consult. At 2:20 PM on 6/4/15, review of the laboratory test results revealed the resident's Pre-[MEDICATION NAME] was low at 12 and the Hemoglobin and Hematocrit were also low at 8.9 and 25.4 g/dl (grams per deciliter). At 2:47 PM, review of the weight record revealed the resident's weight on admission, 3/11/15, was 133.6 pounds. Further review revealed the resident's weight was 124.3 pounds on 5/25/15, a loss of 9.3 pounds. Review of the Dietary Progress Notes revealed a note dated 5/21/15 that stated the resident had a 9.3% weight loss in 30 days. The RDLD (Registered Licensed Dietician) recommended on 5/21/15 changing the Mighty Shakes three times a day to MedPass 120 milliliters twice a day for increased calories and protein. Review of the Medication Record revealed the Mighty Shakes continued through the days of the survey. A second review of the Telephone orders revealed no order changing the supplement. During an interview on 6/4/15 at 2:40 PM, Registered Nurse (RN) #3 stated the RDLD usually writes the order or tells the charge nurse who then writes the order. The RN confirmed the RDLD recommendation to change the supplement and that no order was in the record. The RN stated s/he did not know why the order was not written and confirmed the resident continued to receive the Mighty Shakes. | 2018-11-01 |
| 5614 | 5614 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2015-06-04 | 332 | D | 0 | 1 | 02VR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews and interviews the facility failed to ensure that it was free of a medication error rate of five percent or greater. The medication error rate was 6.7% (percent). There were 2 errors out of 30 opportunities for error. The findings included: On 6/2/15 at approximately 9:27 AM during observation of medication pass on the Unit 2 (200 Hall) , RN (Registered Nurse) # 1 administered the following medications to Resident A ERROR # 1: Two puffs of [MEDICATION NAME] 80-4.5 mcg (microgram) Inhaler by mouth and did not have the Resident rinse his/her mouth with water and then spit out the rinse water. ERROR # 2: Two tablets of vitamin D-3 2,000 units with Calcium [MEDICATION NAME] 90 mg (milligrams). During medication reconciliation on 6/2/15 at 9:40 AM, the physicians orders for June, (YEAR) stated [MEDICATION NAME] 80-4.5 MCG HALER ([MEDICATION NAME]/[MEDICATION NAME]) INHALE 2 PUFFS BY MOUTH TWICE A DAY *RINSE MOUTH WITH WATER & SPIT WITH USE). and VITAMIN D-3 2,000 UNITS ([MEDICATION NAME] (VITAMIN D3)) TAKE 2 TABLETS (4000 UNITS) BY MOUTH DAILY. On 6/2/15 at approximately 10:50 AM, RN # 1 verified that the mouth of Resident A had not been rinsed with water after administration of the [MEDICATION NAME] Inhaler and that the two tablets of vitamin D-3 2,000 units given to Resident A should not have contained Calcium [MEDICATION NAME]. | 2018-11-01 |
| 5615 | 5615 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2015-06-04 | 441 | D | 0 | 1 | 02VR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview the staff failed to wash/sanitize hands after removing gloves and proceeded to place unused supplies back into the treatment cart. ( 1 of 1 wound care treatments observed.) Findings included: The facility admitted Resident # 6 with [DIAGNOSES REDACTED]. An observation of wound care was made on 6/3/15 at 2:30 PM by RN#2 (Registered Nurse). The wound care treatment was completed with no issues until the nurse cleaned the soiled supplies off the overbed table, placed them into a plastic bag and removed his/her gloves. The nurse did not wash/ sanitize his/her hands after glove removal before picking up unused supplies, opening room door, opening drawers to treatment cart, and placing supplies into treatment cart. The nurse then went to the soiled utility room, placed bag of soiled supplies into the barrel, and washed his/her hands. The nurse confirmed in an interview at 4 PM on 6/3/15 that she did not wash her hands before leaving the resident's room before putting supplies back into the treatment cart. The facility Dressing Change, Clean Protocol documents Remove gloves with all unused supplies in plastic bag/container. Assist resident to comfortable position. Cleanse hands. | 2018-11-01 |
| 5616 | 5616 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2015-06-04 | 490 | L | 0 | 1 | 02VR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews and interviews the Administrator failed to train and/or provide a job description for the facility Maintenance Director which contributed to immediate jeopardy and/or substandard quality of care. The findings include: Cross refer CFR 483.25 F-323 Free of Accident Hazards On 6/3/15 at approximately 10:00 AM a review of the Maintenance Director personnel file revealed the Date of Hire as Floor Tech: 8/16/13 and Promoted to Maintenance Director/Housekeeping Supervisor: 9/26/14. Further review failed to show a job description or evidence of training for the Maintenance Director. The Administrator stated that s/he was unable to locate a Maintenance Director job description or a record of training for the Maintenance Director. The Administrator was notified at approximately 5:00PM on 6/2/2015 of the Immediate Jeopardy and/or Substandard Quality of Care related to excessive hot water temperatures in resident rooms. An Allegation of Compliance (A[NAME]) was submitted by the facility on 6/3/15 at approximately 8:45 AM. The actions listed in the A[NAME] included the following: I. Corrective Action taken to remove the Immediate Jeopardy: On 6/2/2015 at approximately 5:00pm (sic), the survey team notified the facility that an Immediate Jeopardy situation was present in regards to Hot Water Temperatures on the 200 Unit. The survey team stated that resident room temperatures on the 200 Unit were in excess of 120 degrees (highest temperature reported was 124 degrees). It was stated by the survey team leader that excessive temperatures were limited to the 200 Unit and that the other Unit's temperatures (100 Unit) were in compliance. The Administrator informed the nursing staff on the 200 Unit to cease using hot water on 6/2/15 at approximately 5:20pm (sic) until the situation was resolved. On 6/2/15 The DON, in coordination with the Licensed Nursing Staff completed 100% body audits on all residents on both units to ensur… | 2018-11-01 |
| 5617 | 5617 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2015-06-04 | 496 | E | 0 | 1 | 02VR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, interviews and review of the facility's policy entitled Background Screening Investigation, the facility failed to conduct Certified Nursing Assistant (CNA) registry verifications prior to date of hire for 5 of 18 CNAs. The findings included: On 6/3/15, during review of the employee files for the extended survey, it was noted that 5 of 18 Certified Nursing Assistant (CNA) registry verifications were conducted on or after the date of hire for 5 of 18 CNAs. Review of the facility's policy entitled Background Screening Investigations indicated in . Policy Interpretation and Implementation . 2. For individuals applying for a position as a Certified Nursing Assistant, the state nurse aide registry will be contacted to determine if any findings of abuse, neglect, mistreatment of [REDACTED]. The findings were confirmed during an interview with the Human Resources staff. | 2018-11-01 |
| 5618 | 5618 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2015-06-04 | 501 | C | 0 | 1 | 02VR11 | Based on interview and review of the facility's files in conjunction with the Extended Survey, the facility failed to have a valid contract for the Medical Director. The findings included: On 6/3/15 at approximately 10:00 AM, review of the facility's contracts revealed a Medical Director Agreement dated (MONTH) 1, 2014 and renewed automatically for successive annual renewal terms thereafter. Further review revealed the contract was signed by the Nursing Home Administrator. There was no signature as to the Physician and there was no witness signature to the Administrator. At approximately 11:30 AM, the Administrator confirmed the contract was not signed. | 2018-11-01 |
| 5619 | 5619 | WOODRUFF MANOR | 425179 | 1114 EAST GEORGIA ROAD | WOODRUFF | SC | 29388 | 2015-06-04 | 520 | L | 0 | 1 | 02VR11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on full and/or limited record reviews, interviews, and review of the facility policies, it was determined on 6/2/15 at approximately 5:02 PM Immediate Jeopardy and/or Substandard Quality of Care existed for CFR 483.75 F-520 which was identified at a scope and severity level of (L). The facility failed to ensure that the Quality Assurance (QA) process was utilized to identify, monitor and implement a plan of action to ensure routine monitoring of water temperatures to prevent potential injuries to residents. The findings included: Cross refer CFR 483.25 F-323 Free of Accident Hazards CFR 483.25 F-323 was identified at a scope and severity level of (L). The Immediate Jeopardy existed on 6/2/15 when water temperatures were checked on initial tour in thirteen resident bathrooms on Unit 2 and observed to be too hot. On 6/2/15 at approximately 9:30 AM Surveyor Team thermometers were used to check all facility bathrooms. Thirteen resident bathrooms on Unit 2 were found to have hot water temperatures of approximately 121-124 degrees F (Fahrenheit). During an interview on 6/4/15 at approximately 5:30 PM, the facility Administrator confirmed the facility had not identified the water temperatures as being a concern. The Administrator stated the facility had no QA in process relative to the concern. The Administrator stated that the QA Committee identified concerns through the Quality Measures, Bench Mark Reports the 24 Hour Reports, Incident Reports, Grievances, Customer Satisfaction Surveys, the Guardian Angel Program, and the Interact Stop and Watch to identify residents' changes in condition to prevent re-hospitalization s. The Administrator was notified at approximately 5:00PM on 6/2/2015 of the Immediate Jeopardy and/or Substandard Quality of Care related to excessive hot water temperatures in resident rooms. An Allegation of Compliance (A[NAME]) was submitted by the facility on 6/3/15 at approximately 8:45 AM. The actions listed in the A[NAM… | 2018-11-01 |
| 1182 | 1182 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2018-01-24 | 600 | D | 1 | 0 | 8P6T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on limited record review, interview and review of the facility's abuse policy, the facility failed to maintain a safe environment, free from potential abuse for Resident #1. One of three facility reported incidents reviewed. The findings included: The facility reported an allegation of abuse to the State Agency on 10/24/17 for Resident #1. On 10/23/17 Sitter #1 and Sitter #2 heard a verbal altercation between CNA (certified nursing aide) #1 and Resident #1. It was reported that CNA #1 was talking loud toward Resident #1 and stated that s/he was going to get a relative to beat her/his ass. The required 5-day report was sent to the State Agency on [DATE]. The report concluded with the following statement, It is the decision of this Administrator that due to evidence presented the employee will be terminated for Verbal Abuse toward a resident. Resident #1 was admitted to the facility with [DIAGNOSES REDACTED]. The most recent assessment of her/his cognitive status was conducted on 11/13/17 using the Minimum Data Set for a Quarterly review and revealed a score of 7 out of a possible 15 points. Previous assessments revealed the same scoring, which is indicative of severe cognitive impairment. The resident required assistance from staff and/or assistive devices with Activities of Daily Living (ADLs) - bathing, dressing, grooming. Sitter #1 reported to administration that CNA #1 was talking loud toward Resident #1 and heard CNA #1 tell Resident #1 not to push on her/him and that CNA #1 would bring a relative to beat Resident #1's ass. During a phone interview on 1/24/18 at 2:04 p.m. with the surveyor, Sitter #1 stated, I told them what I heard. S/he stated there would be no changes made to the statement provided to administration. Sitter # 2 reported to administration that CNA #1 told Resident #1 not to put her/his hands on her/him (CNA#1) and CNA #1 would have a relative come to beat her/his ass. During an interview on 1/23/18 at 3:19 p.m. … | 2020-09-01 |
| 1183 | 1183 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2018-01-24 | 607 | D | 1 | 0 | 8P6T11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review the facility failed to ensure established policies were implemented to prevent the verbal abuse of Resident #1. One of three facility reported incidents reviewed. The findings included: An alleged verbal altercation between CNA (Certified Nursing Aide) #1 and Resident #1 on 10/23/17 was reported to the State Agency and investigated by the facility's administration. The findings of the facility's investigation resulted in the termination of CNA #1. Review of CNA #1's employee file revealed the staff member had received the mandatory training and in-servicing regarding abuse, however the incident resulted in a substantiated allegation of verbal abuse, which was identified in the facility's 5-day reporting. Resident #1 was admitted to the facility with [DIAGNOSES REDACTED]. The most recent assessment of her/his cognitive status was conducted on 11/13/17 using the Minimum Data Set for a Quarterly review and revealed a score of 7 out of a possible 15 points. Previous assessments revealed the same scoring, which is indicative of severe cognitive impairment. The resident required assistance from staff and/or assistive devices with Activities of Daily Living (ADLs) - bathing, dressing, grooming. Sitter #1 reported to administration that CNA #1 was talking loud toward Resident #1 and heard CNA #1 tell Resident #1 not to push on her/him and that CNA #1 would bring a relative to beat Resident #1's ass. During a phone interview on 1/24/18 at 2:04 p.m. with the surveyor, Sitter #1 stated, I told them what I heard. S/he stated there would be no changes made to the statement provided to administration. Sitter # 2 reported to administration that CNA #1 told Resident #1 not to put her/his hands on her/him (CNA#1) and CNA #1 would have a relative come to beat her/his ass. During an interview on 1/23/18 at 3:19 p.m. with the surveyor, Sitter #2 stated CNA #1 was verbally abusive to Resident #1 and wished to make no changes to her/his in… | 2020-09-01 |
| 1184 | 1184 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2017-02-02 | 226 | D | 0 | 1 | 9SOB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and review of the facility policy titled Abuse: Preventing Resident Abuse the facility failed to implement policies related to abuse in the areas of Prevention, Protection and Reporting of abuse for 1 of 1 resident reviewed for abuse. (Resident #8) The findings included: The facility admitted Resident #8 with [DIAGNOSES REDACTED]. Record review revealed on 12/25/16 an alleged incident of verbal abuse was reported to the State Survey Agency with a conclusion after an investigation of verbal abuse on 12/29/16. Witness statements were obtained with a date of 12/26/16 and 12/29/16. The incident was reported to the facility on [DATE] at which time an investigation was begun. During an interview with the Administrator on 2/1/17 at 4:30 PM, he/she stated that a 24 hour report had not been sent in as required due to the incident had been filed as a grievance. He/she continued by stating once the grievance was filed it was determined that the incident should be classified as verbal abuse. The Administrator stated after the Certified Nursing Assistant was suspended, he/she did enter the building and spoke with the Resident #8 to apologize. The Administrator continued by stating CNA #7 was instructed not to come into the building until he/she was called back. During an interview with Resident #8 on 2/02/17 2:50 PM, he/she stated everyone treated him/her good. Resident #8 was asked if anyone had told him/her they would not give him/her the care he/she needed and again he/she stated no. Review of the facility policy titled Abuse: Preventing Resident Abuse states the following: 2f- Helping staff to deal appropriately with stress and emotions, and 2i -Monitoring staff on all shifts to identify inappropriate behaviors toward residents. | 2020-09-01 |
| 1185 | 1185 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2017-02-02 | 241 | D | 0 | 1 | 9SOB11 | Based on observation, interview and review of facility policies titled Assistance with Meals and Quality of Life: Dignity, the facility failed to provide an environment to promote dignity of residents during the dining experience for 1 of 2 dining observations. Staff was observed entering rooms without knocking and placing clothing protectors on residents without permission. The findings included: Observation on 1/30/17 at 7:35 AM of the breakfast dining observation revealed Certified Nursing Assistants(CNA's)#3 and #4 entering resident rooms without knocking. CNA#4 and #5 were observed placing clothing protectors on residents without asking their permission. During an interview with CNA #4 on 2/2/17 at 2:23 PM, he/she stated you should knock and announce self prior to entering the resident's room and you should ask the resident's permission prior to placing a clothing protector on a resident. During an interview with CNA #5 on 2/2/17 at 1:45 PM, he/she stated you should ask the resident's permission prior to placing a clothing protector. Review of the facility policy titled Assistance with Meals section 1(c)(4) states avoid the use of bibs or clothing protectors instead of napkins, unless requested by the resident. Review of the facility policy titled Quality of Life: Dignity section 6a states staff will knock and request permission before entering resident rooms. | 2020-09-01 |
| 1186 | 1186 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2017-02-02 | 309 | D | 0 | 1 | 9SOB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and observation, the facility failed to ensure 1 of 1 resident reviewed for ordered padded side rails received the necessary care and services to attain or maintain the highest practicable physical, mental and psychosocial well being.(Resident #53) Tha findings included: The facility admitted Resident #53 with [DIAGNOSES REDACTED]. The Admission Evaluation and Interim Care Plan, dated 12/13/16, stated the resident needed 1/4 padded side rails, up on both sides when in bed, to define parameters. The Treatment Administration Record (TAR), dated 12/13/16, stated 1/4 side rails (padded), up when in bed to define parameters. The time codes associated with this was FYI. The sheet was not initialed indicating the treatment had been applied. The Physician Admission/Monthly Orders, dated 12/15/16, stated the resident was ordered 1/4 side rails (padded), up on both sides when in bed to define parameters. The Care Plan, last updated 12/20/16, stated the resident required total assistance with Activities of Daily Living (ADLs) related to [DIAGNOSES REDACTED]. Approaches included 1/4 side rails up times 2 when in bed to define parameters as ordered. The physician's orders [REDACTED]. The TAR, dated January, (YEAR), stated 1/4 side rails (padded), up when in bed to define parameters. The time codes associated with this was FYI. The sheet was not initialed indicating the treatment had been applied. The physician's orders [REDACTED]. The TAR, dated February, (YEAR), stated 1/4 side rails (padded), up when in bed to define parameters. The time codes associated with this was FYI. The sheet was not initialed indicating the treatment had been applied. During an observation on 2/1/17 at 10:34 AM, the resident was laying in his bed, two 1/4 side rails were up at the head of the bed. The side rails did not have padding on them. His head was resting on the right side rail. During an observation on 2/1/17 at 11:58 AM AM, the resident… | 2020-09-01 |
| 1187 | 1187 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2017-02-02 | 314 | D | 0 | 1 | 9SOB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, interview and review of the facility policy titled Clarendon Health System LTC: Wound Care Procedure, the facility failed to assure proper technique during wound care for Resident #48. A staff member was observed to clean the outer area of the wound first and after changing gloves did not wash their hands. The findings included: The facility admitted Resident #48 with [DIAGNOSES REDACTED]. During observation of wound care on 2/1/17, Registered Nurse(RN)#2 was observed to clean the wound from the outside edge of the wound, the inside of the wound and repeated the procedure using different saturated gauze pads. He/she then applied skin prep around the wound. Gloves were removed and clean gloves were donned. [MEDICATION NAME] was cut and placed on the wound bed and an Allevyn dressing was applied. Omnifix was cut and placed over the Allevyn dressing. RN#2 removed his/her gloves and washed his/her hands. During an interview with RN#2 on 2/2/17, he/she stated handwashing was not necessary because he/she had not touched anything dirty. Review of the facility policy titled Clarendon Health System LTC: Wound Care Procedure revealed the following:16. Clean the wound according to the order. Clean from center outward. 17. Place soiled gauze used for cleaning in the trash bag. 18. Remove gloves and discard in trash bag. 19. Perform hand hygiene. 20. Glove. 21. Apply clean dressing as ordered. | 2020-09-01 |
| 1188 | 1188 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2017-02-02 | 315 | D | 0 | 1 | 9SOB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, interview and review of the facility policy titled Perineal Care/Incontinent Care, the facility failed to assure Resident #48 received appropriate treatment. During observation of incontinent care, a facility staff member utilized improper technique. The findings included: The facility admitted Resident #48 with [DIAGNOSES REDACTED]. Observation of incontinent care on 1/30/17 at 6:30 AM revealed during care Certified Nursing Assistant(CNA)#2 did not clean the perineal area. He/she only wiped the rectum. During an interview with CNA #2 on 1/30/17 at 6:45 AM regarding the incontinent care, he/she stated he/she was nervous. Review of the facility policy titled Perineal Care/Incontinent Care revealed under section 18b and 18g the following: Wash perineal area starting with urethra and working outward . and wash the rectal area thoroughly . | 2020-09-01 |
| 1189 | 1189 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2017-02-02 | 325 | D | 0 | 1 | 9SOB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interviews, the facility failed to provide a therapeutic diet as ordered for 1 of 3 residents reviewed for nutrition. Resident #15 had a diet order written to substitute mashed potato for rice; and had received rice on his tray during a meal observation. The findings included: The facility admitted Resident #15 with [DIAGNOSES REDACTED]. The Change of Diet order, dated 1/24/17, stated new Diet Order was Reg w ground meats; substitute mashed potatoes for rice for increased safety. The Speech Therapy Plan of Care, signed and dated by the Speech Therapist (ST) dated 1/24/17, and signed by the Physician on 1/26/17, stated the resident had difficulty tolerating chopped meats on several occasions, and had inability to grind food items due to missing teeth. The recommendation included substituting mashed potato for rice to increase safety. During an observation on 2/1/17 at 12:14 PM, the resident was observed with his lunch meal in the dining room. His meal included rice. The resident accepted assistance from Certified Nursing Assistant (CNA) #1; and he also was observed feeding himself bites of food. During an interview on 2/1/17 at 4:17 PM the Certified Dietary Manager (CDM) stated when the ST made a diet recommendation, he received the Change of Diet Order slip from nursing. He stated he did not have a diet order slip for the resident at that time. He stated the resident's current diet was Regular, ground meat, large portions at lunch and supper. He stated it is the responsibility of him or the Assistant Dietary Manager to make a note of specific diet instructions on the resident's meal ticket. He stated he thinks the resident was Ok with receiving rice at the time. During an interview with the ST on 2/1/17 at 4:27 PM she stated she had recommended substituting the mashed potato for the rice as the resident had been coughing on the rice. She stated the resident has missing teeth, no dentures and was tolerat… | 2020-09-01 |
| 1190 | 1190 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2017-02-02 | 332 | D | 0 | 1 | 9SOB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interview and review of the Toujeo insert titled, Toujeo [MEDICATION NAME] (insulin [MEDICATION NAME] injection) 1.5 mL disposable prefilled pen, the facility failed to ensure a medication administration error rate of 5 percent or less during med pass. The med error rate was 6.896 percent with 30 opportunities for error. The findings included: The facility admitted Resident #8 with a [DIAGNOSES REDACTED]. On 1/30/2017 at approximately 8:00 AM during medication administration to Resident #8, Licensed Practical Nurse (LPN) #1 administered Toujeo via a flex pen, 60 units in 2 injections. Upon administering the 2 injections LPN #1 failed to hold the injection button, with the needle in the skin, and slowly count to 5 before removing the needle from the skin for both injections resulting in a 6.896 percent medication administration error rate. During an interview on 1/30/2017 at approximately 8:10 AM LPN #1 would not comment on the amount of time the needle was left in the skin, but went on to say that he/she had been inserviced on the correct administration of the Toujeo flex pen. Review on 1/30/2017 at approximately 10:20 AM of the Toujeo Flex Pen package insert from the manufacturer titled, Toujeo [MEDICATION NAME] (insulin [MEDICATION NAME] injection) 1.5 mL disposable prefilled pen, revealed the following instructions: Step 5: Inject your dose. 5[NAME] Choose a place to inject 5B. Push the needle into your skin. 5C. Place your thumb on the injection button. Then press all the way in and hold. 5D. Keep the injection button held in and when you see 0 in the dose window, slowly count to 5. 5E. After holding and slowly counting to 5, release the injection button. Then slowly remove the needle from the skin. LPN #1 failed to follow the manufacturer's instructions for administering the Toujeo to Resident #8. | 2020-09-01 |
| 1191 | 1191 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2017-02-02 | 371 | E | 0 | 1 | 9SOB11 | Based on observation, Interview and policy review, the facility failed to prepare and store food under sanitary conditions for 1 of 1 kitchen; and failed to serve food under sanitary conditions during 1 of 4 dining observations. The findings included: During a meal observation on 1/30/2017 12:20:17 PM, Certified Nursing Assistant (CNA) #2 touched a biscuit with her bare hands and served the biscuit to a resident. During an interview on 2/2/17 at 12:29 PM, CNA #2 stated the proper way to serve food was to use hand sanitizer between serving each tray and to not touch food with a bare hand. She stated she didn't want to touch the biscuit with her bare hand but she did because she can't use gloves. She stated no one has ever told her she shouldn't touch a biscuit with her bare hands During an interview on 2/2/2017 at 2:06 PM, the Infection Control Nurse states she did not believe training for safe food handling had been included in orientation for nurses and CNAs. She stated her expectation is that staff should not have touched ready to eat food items with bare hands. She stated training on serving food has not been done since she had been working there. The Assistance with Meals policy, dated (MONTH) 2013, stated avoid handling food with bare hands. During a follow up tour of the kitchen on 1/31/17 at 10:52 AM, a fan with built up dust on it was stored next to the emergency food supply. The Dietary Manager confirmed the observation and stated the fan would be moved. In refrigerator #1, a package of opened cheese was not labeled or dated. The DM stated this food was used for activities. In the walk-in cooler dust was observed on the fan and the fan covering; the Dietary Manager confirmed this observation. Observation of breakfast dining on 1/30/17 at 7:35 AM on the [NAME]ina Hall revealed CNA #3 touching bread with his/her bare hand on two opportunities. CNA #4 was observed to pick a clothing protector off the floor and place it on a resident. Observation of breakfast dining on 1/30/17 at 7:50 AM revealed CNA #5 was … | 2020-09-01 |
| 1192 | 1192 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2017-02-02 | 431 | E | 0 | 1 | 9SOB11 | Based on observations, interviews and review of the facility policy titled, Storage of Medications, the facility failed to ensure expired medications were removed from the medication carts and a treatment cart and not stored with other medications for resident use in 2 of 2 medication carts and and 1 of 2 treatment carts. The findings included: An observation on 1/30/2017 at approximately 2:20 PM of the Virginia Hall medication cart revealed the medication Morphine Sulfate 100 mgs (milligrams) per 5 mls (milliliters), (20 mg/ml) with Lot # 1C, Manufactured by Roxane Laboratories with a total of 27 mls was expired. The expired Morphine Sulfate was confirmed by the Director of Nursing at this time and removed from the med cart. An observation on 1/30/2017 at approximately 3:15 PM of the [NAME]ina Hall medication cart revealed one vial of Novolog Insulin opened on 12/30/2016 and expired on 1/28/2017. The expired Novolog Insulin was removed from the med cart and was confirmed to be expired by Licensed Practical Nurse (LPN) #1 at this time. An additional observation of the medication cart on the [NAME]ina Hall on 1/30/2017 at approximately 3:20 PM revealed 6 tablets of the medication Ondansetron Lot #EX4307 and manufactured by Sandoz had expired on 11/20/2016. The Ondansetron was removed from the med cart and was confirmed at this time by LPN #1. An observation on 1/30/2017 at approximately 3:35 PM of a treatment cart on the [NAME]ina Hall revealed a bottle of Somahesive Powder 1 ounce had expired on 12/2015 with Lot #2M106 and was Manufactured by ConvaTec.The findings were confirmed at this time by the DON. Review on 2/1/2017 at approximately 9:38 AM of the facility policy titled, Storage of Medications, states, under Purpose, The purpose of this procedure is to ensure that medications are stored in a safe, secure, and orderly manner, Under , General Guidelines # 3 states, No discontinued, outdated, or deteriorated medications are available for use in this facility. All such medications are destroyed. | 2020-09-01 |
| 1193 | 1193 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2017-02-02 | 441 | E | 0 | 1 | 9SOB11 | Based on record review, observation, interview and review of facility policies titled Assistance with Meals and Perineal Care/Incontinent Care, the facility failed to maintain an infection control program designed to provide a safe, sanitary and comfortable environment and to prevent the development and transmission of disease and infection for 1 of 1 incontinent care observed.(Resident #48). In addition, during meal service, staff were observed touching bread with their bare hands, not sanitizing hands between delivery of trays and placed an unclean clothing protector on a resident. Linen barrels on the Virginia Hall were overflowing and a trash liner with trash was noted on the floor of the shower room. The findings included: The facility admitted Resident #48 with diagnoses, which included but not limited to, Decubitus Ulcer, Dementia and Failure to Thrive. After observing incontinent care on 1/30/17 at 6:30 AM, Certified Nursing Assistant(CNA) #2 was observed touching pillows, handling the personal wipes container, placing a soiled brief on the resident's bed and repositioning the resident wearing the soiled gloves used to provide incontinent care. During disposal of trash/linen after the incontinent care was given, the linen barrels on the Virginia Hall were overflowing and would not close and a trash liner with trash was noted sitting on the floor of the shower room. During an interview with CNA #2 on 1/30/17 at 6:45 AM, he/she stated he/she was nervous during the procedure. Observation of breakfast dining on 1/30/17 at 7:35 AM on the [NAME]ina Hall revealed CNA #3 touching bread with his/her bare hand on two opportunities. CNA #4 was observed to pick a clothing protector off the floor and place it on a resident. Observation of breakfast dining on 1/30/17 at 7:50 AM revealed CNA #5 was observed several times not washing/sanitizing his/her hands during the delivery of meal trays. CNA #6 was observed touching the mouth part of a straw with his/her bare hand and at times not washing his/her hands between tray … | 2020-09-01 |
| 1194 | 1194 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2018-04-06 | 550 | D | 0 | 1 | YXGL11 | Based on observations, interview, and review of the facility ' s policy titled, Maintaining Dignity, and Assistance with Meals, the facility failed to provide an environment to promote dignity of residents during the dining experience for 2 of 2 dining observations on the VA Unit. Staff was observed entering rooms without knocking and placing clothing protectors on residents without first asking if they would like to have one applied. The findings included: An observation on 4/3/2018 at approximately 11:47 AM during the lunch meal service on the VA Unit revealed CNA's (Certified Nursing Assistants) yelling knock, knock, and then entering rooms, not waiting for a response to enter, and applying clothing protectors without first asking if they would like to have one applied. An observation on 4/6/2018 at approximately 11:55 AM during the lunch meal service on the VA Unit revealed CNA's passing out lunch trays. The CNA's were yelling knock, knock, and then entering rooms, not waiting for a response to enter, and applying clothing protectors without first asking if they would like to have one applied. An interview on 4/6/18 at 12:10 PM with CNA #1 confirmed the findings, and she stated, We are working on that. Review on 4/6/2018 at approximately 1:20 PM of the facility policy titled, Maintaining Dignity, policy statement reads, To ensure the residents are cared for in a manner and in an environment that maintains or enhances their dignity and respect. Under, Policy Interpretations and Implementation, number 6. states, Resident's private space and property will be respected, TV/Radio station will not be changed without resident's permission, resident room doors will be knocked on and permission to enter granted prior to entering resident rooms, resident room doors will be open or closed per resident choice, resident's personal items will not be moved or inspected without residents permission. Review on 4/6/2018 at approximately 1:30 PM of the facility policy titled Assistance with Meals, states under, Policy Interpret… | 2020-09-01 |
| 1195 | 1195 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2018-04-06 | 623 | D | 0 | 1 | YXGL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on limited record reviews, and interviews, the facility failed to ensure that a representative of the Office of the State Long-Term Care Ombudsman was notified of the transfers and discharges of residents for 1 of 1 reviewed for discharge. Resident#52 was discharged from the facility without notification provided as required to the State Long-Term Care Ombudsman. The findings included: The facility admitted Resident# 52 on 6/29/17 with [DIAGNOSES REDACTED]. During limited record review on 4/5/18 at 1:29 PM revealed Discharge from Windsor Manor listed Resident#52 was discharged home on[DATE]. The memory transmission report have the Ombudsman's fax number with the end date 4/5/18. In addition discharges from (MONTH) (YEAR) through (MONTH) (YEAR) were sent on 4/5/18. During an interview on 4/5/18 at 1:29 PM with the Administrator stated talked to Social Services Director about sending information to the Ombudsman and was not aware. Administrator called the Ombudsman and ask how they prefer to receive the information. | 2020-09-01 |
| 1196 | 1196 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2018-04-06 | 641 | C | 0 | 1 | YXGL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and review of the facility policy titled, Weight Assessment and Intervention, the facility failed to ensure the MDS (Minimum Data Set) assessment dated [DATE] for Resident #15 was coded accurately related to weight loss for 1 of 5 residents reviewed for nutrition. The findings included: The facility admitted Resident #15 with [DIAGNOSES REDACTED]. Review on 4/5/2018 at approximately 7:24 PM of a form titled, Weight Chart, revealed a weight on 10/24/2017 of 153 pounds. The weight on 11/19/2017 was 169 pounds. The weight on 12/8/2017 was 152 pounds. No documentation could be found in the medical record to ensure Resident #15 was reweighed to ensure accuracy. Review on 4/5/2018 at approximately 7:54 PM of the MDS assessment dated [DATE] for Resident #15 revealed a transmitted weight of 169 pounds. During an interview on 4/5/2018 at approximately 6:20 PM with the RN (Registered Nurse) Consultant stated, we usually reweigh the residents and then weigh them for three days consecutively. An interview on 4/5/2018 at approximately 7:00 PM with the Administrator confirmed the error and he/she stated, I would have reweighed the resident. A corrected MDS was transmitted on 4/5/2018 and was presented by the Administrator. Review on 4/5/2018 at approximately 7:15 PM of the facility policy titled, Weight Assessment and Intervention, under Policy Statement, The multidisciplinary team will strive to prevent, and intervene for undesirable weight loss for our residents. Under Weight Assessment, number 3 states, Any weight change of 5 percent or more since the last weight assessment will be retaken the next day for confirmation. If the weight is verified, nursing will immediately notify the Dietician in writing. Verbal notification must be confirmed in writing. Number 4 states, The Dietician will respond within 24 hours of receipt of written notification. . | 2020-09-01 |
| 1197 | 1197 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2018-04-06 | 657 | D | 0 | 1 | YXGL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure the CNA (Certified Nursing Assistant) had input into the care planning process for Resident #20 for 1 of 15 residents reviewed for Participation in Care Planning. The findings included: The facility admitted Resident #20 with [DIAGNOSES REDACTED]. Review on 4/6/2018 at approximately 2:30 PM of a form titled, Resident Care Plan Conference Attendance Record, dated 11/29/2016 and 2/14/2017 indicated that the CNA involved in the care for Resident #20 did not have input into the care planning process for Resident #20. During an interview on 4/6/2018 at approximately 2:50 PM the Social Service Director confirmed that the CNA most involved with the care for Resident #20 did not have input into the care planning process. | 2020-09-01 |
| 1198 | 1198 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2018-04-06 | 659 | E | 0 | 1 | YXGL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on limited record review and interview the facility failed to ensure services were provided in accordance with the written comprehensive plan of care for 1 of 5 residents reviewed for unnecessary medications. Resident # 50's care plan states to chart any behaviors as indicated. The findings included: The facility admitted Resident# 50 on 4/23/15 with [DIAGNOSES REDACTED]. During review of the April's (YEAR) physician's orders [REDACTED]. During record review on 4/5/18 at 11:15AM revealed the Care Plan with problem onset: 3/20/18 Potential for undesirable side effects related psychoactive drug therapy receives [MEDICATION NAME] related to Depression. Approaches observe/assess and report signs and symptoms of drug induced postural [MEDICAL CONDITION]. Chart any behaviors as indicated. Further record review on 4/5/18 at 12:07 PM revealed no documentation on the Medication Administration and the Nurses' Notes of the resident's behaviors. During an interview on 4/6/18 with Registered Nurse# 1 stated the facility did not have to document the resident being on [MEDICATION NAME]. Surveyor stated according to the care plan Resident#50 should be. | 2020-09-01 |
| 1199 | 1199 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2018-04-06 | 690 | D | 0 | 1 | YXGL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure to provide quality care for Resident #29, the physician was not notified of laboratory findings for 1 of 2 residents reviewed for Urinary Tract Infection [MEDICAL CONDITION]. There was no evidence that the facility notified the Physician of abnormal laboratory findings for Resident #29 resulting in a 5-day delay in treatment. The findings included: Resident #29 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of physician's orders [REDACTED]. Lab results reviewed on 4/5/18 at 11:04 AM, revealed a UA was obtained on 3/21/18 as ordered and received by the lab on 3/22/18. The lab results were reported to the facility on [DATE] at 09:34 AM. There was no evidence that the facility notified the Physician of the UA results. The Physician signed and dated the lab results 3/29/18 and noted orders written on the lab sheet. Physician order [REDACTED]. In an interview with the Director of Nursing (DON) on 4/5/18 at approximately 11:40 AM, the DON stated, Either the Unit Manager or Floor Nurse write any pertinent information on the lab results and fax it to the Physician and they call back or fax over orders. The DON verified there was no evidence of staff notifying the Physician of the abnormal UA after receiving the results 3/24/18. During a phone interview on 4/5/18 at approximately 3:00 PM, Other Staff #3 stated, I expect the nurses to call me with any abnormal lab results, even on a weekend. When asked if an antibiotic would have been indicated on 3/24/18 based on the UA results, Other Staff #3 stated, Probably so. | 2020-09-01 |
| 1200 | 1200 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2018-04-06 | 692 | D | 0 | 1 | YXGL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and review of the facility policy titled, Weight Assessment and Intervention, the facility failed to ensure Resident #15 maintained acceptable parameters of nutritional status related to documented weights for 1 of 5 residents reviewed for Nutrition. The findings included: The facility admitted Resident #15 with [DIAGNOSES REDACTED]. Review on 4/5/2018 at approximately 7:24 PM of a form titled, Weight Chart, revealed a weight on 10/24/2017 of 153 pounds. The weight on 11/19/2017 was 169 pounds. The weight on 12/8/2017 was 152 pounds. No documentation could be found in the medical record to ensure Resident #15 was reweighed to ensure accuracy. Review on 4/5/2018 at approximately 7:54 PM of the MDS assessment dated [DATE] for Resident #15 revealed a transmitted weight of 169 pounds. During an interview on 4/5/2018 at approximately 6:20 PM with the RN (Registered Nurse) Consultant stated, we usually reweigh the residents and then weigh them for three days consecutively. An interview on 4/5/2018 at approximately 7:00 PM with the Administrator confirmed the error and he/she stated, I would have reweighed the resident. A corrected MDS was transmitted on 4/5/2018 and was presented by the Administrator. Review on 4/5/2018 at approximately 7:15 PM of the facility policy titled, Weight Assessment and Intervention, under Policy Statement, The multidisciplinary team will strive to prevent, and intervene for undesirable weight loss for our residents. Under Weight Assessment, number 3 states, Any weight change of 5 percent or more since the last weight assessment will be retaken the next day for confirmation. If the weight is verified, nursing will immediately notify the Dietician in writing. Verbal notification must be confirmed in writing. Number 4 states, The Dietician will respond within 24 hours of receipt of written notification. . | 2020-09-01 |
| 1201 | 1201 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2018-04-06 | 760 | D | 0 | 1 | YXGL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure Resident #351 received a physician ordered medication for agitation for 1 of 1 resident reviewed for Mood and Behavior. In addition, the facility failed to ensure Resident #351 admitted on [DATE] received PM physician ordered medications due to unavailability. The findings included: The facility admitted Resident #351 on 3/8/2018 with [DIAGNOSES REDACTED]. Review on 4/6/2018 at 9:41 AM of the MAR ( Medication Administration Record) for Resident #351 for (MONTH) 8 - 31, (YEAR) revealed the medication [MEDICATION NAME] 60 mg (milligrams) to be given 4 times daily was not administered on 3/8/2018 at 6:00 PM and 12:00 AM. The medication [MEDICATION NAME] 20 mg to be administered 2 times daily was not administered at 6:00 PM. The medication [MEDICATION NAME] 800 mg to be administered 2 times daily was not administered at 6:00 PM and the medication [MEDICATION NAME] 37.5 mg to be administered 2 times daily was not administered on 3/8/2018 at 6:00 PM. [MEDICATION NAME] 10 mg ordered for bedtime and on the MAR for 8:00 PM was not administered. The medication [MEDICATION NAME] 1 mg due on 3/8/2018 at 8:00 PM was not administered. The medication [MEDICATION NAME] 25 mg to be administered at 6:00 PM on 3/8/2018 was not administered . All the above medications were not signed on the MAR indicated [REDACTED] An interview on 4/6/2018 at approximately 11:07 AM with the DON (Director of Nursing) confirmed that the medications ordered PM doses of medications ordered on admission were not administered. The Administrator verbalized that he/she was sure the medications were given, but were not documented as given. Review on 4/6/2018 at approximately 10:00 AM of the physician orders [REDACTED].#351 [MEDICATION NAME] 1 mg (milligram) via a G tube related to agitation and constant yelling out. Review on 4/6/2018 at approximately 10:20 AM of the MAR (Medication Administration Record) for Resident #3… | 2020-09-01 |
| 1202 | 1202 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2018-04-06 | 761 | E | 0 | 1 | YXGL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Medication labeling and storage Based on observations, interviews, and review of the facility ' s policy, the facility failed to label insulin pens accurately and ensure an accurate count of [MEDICATION NAME] in 2 of 2 medication carts and 1 of 1 refrigerator. The findings included: During inventory of the [NAME]ina Hall medication cart on [DATE] at approximately 11:33 AM with RN #2, a Narcotic Inventory Record was found with [MEDICATION NAME] 2 milligrams (mg)/milliliter (ml) beginning quantity 2 on [DATE], however, the amount remaining was changed to 1 with no explanation listed. RN #2 stated, There is one [MEDICATION NAME] vial for each hall. I just count one. During an observation of the Virginia Hall narcotic count on [DATE] at approximately 07:17 PM, LPN #2 and LPN #3 checked for 1 vial of [MEDICATION NAME] 2 mg/ml in the refrigerator. They stated, We check for 1 vial and the other hall ([NAME]ina) checks for 1 vial. However, both vials in the refrigerator were labeled for [NAME]ina Hall. In addition, the Virginia Hall narcotic sheet labeled for (MONTH) (YEAR) was mislabeled as [MEDICATION NAME] 0.5 mg tablet in the refrigerator instead of [MEDICATION NAME] 2 mg/ml. There was no narcotic sheet to sign for [MEDICATION NAME] 2 mg/ml. The total amount of [MEDICATION NAME] vials in the refrigerator was not documented. During inventory of the medication cart on [NAME]ina Hall on [DATE] at approximately 11:05 AM with RN #2, multiple vials of the same insulin was found for Resident #35. Two vials of [MEDICATION NAME] 100 unit(u)/ml vial were found. The first vial had a label showing the date opened [DATE] and expiring [DATE], totaling 32 days. RN #2 verified the insulin should expire in 28 days on [DATE] but was mislabeled. The second vial was labeled as opened on [DATE] and expiring on [DATE], totaling 43 days. RN #2 verified the insulin should be labeled to expire on [DATE], totaling 28 days. The second vial was in a box labeled with a date … | 2020-09-01 |
| 1203 | 1203 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2018-04-06 | 773 | D | 0 | 1 | YXGL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on limited record review, interview, and review of facility policy, the facility failed to ensure the physician had been notified of laboratory findings for 1 of 2 residents reviewed for Urinary Tract Infection [MEDICAL CONDITION]. There was no evidence that the facility notified the physician of abnormal laboratory findings for Resident#29. The findings included: Resident #29 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of Physician's Orders on 4/5/18 at approximately 1:00 PM, revealed an order on 3/21/18 to obtain a Urinalysis (UA) with Culture and Sensitivity (C&S) by using a catheter, for symptoms of a UTI including dysuria (painful urination) and frequent urination. Lab results reviewed on 4/5/18 at 11:04 AM, revealed a UA was obtained on 3/21/18 as ordered and received by the lab on 3/22/18. The lab results were reported to the facility on [DATE] at 09:34 AM. There was no evidence that the facility notified the Physician of the UA results. The Physician signed and dated the lab results 3/29/18 and noted orders written on the lab sheet. Physician order reviewed also from 3/29/18 reveals an antibiotic order of [MEDICATION NAME] 1 Gram, Intramuscular injection (IM), every 12 hours x 3 days for UTI. In an interview with the Director of Nursing (DON) on 4/5/18 at approximately 11:40 AM, the DON stated, Either the Unit Manager or Floor Nurse write any pertinent information on the lab results and fax it to the Physician and they call back or fax over orders. The DON verified there was no evidence of staff notifying the Physician of the abnormal UA after receiving the results 3/24/18. During a phone interview on 4/5/18 at approximately 3:00 PM, Other Staff #3 stated, I expect the nurses to call me with any abnormal lab results, even on a weekend. If they didn't note it somewhere, I didn't know. When asked if an antibiotic would have been indicated on 3/24/18 based on the UA results, Other Staff #3 stated, Proba… | 2020-09-01 |
| 1204 | 1204 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2018-04-06 | 812 | F | 0 | 1 | YXGL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews, and interviews, the facility failed to ensure: 1) Expired foods were discarded, 2) The Dietary Cook was appropriately handling raw chicken and utilizing appropriate hand washing after touching raw chicken with bare hands and before touching clean serving utensils and clean knife, 3) Tube Feedings were not stored in the employee restroom (toilet in room) in 1 of 1 reviewed kitchen and 1 of 2 employee restrooms in the facility. The findings included: An observation made during the initial tour on [DATE] at 9:55 AM, while in the walk-in cooler of a container of gravy and hamburger patties, the label stated Exp ,[DATE] (Expires ,[DATE]). The Dietary Manager verified and discarded. A second observation made while in the walk-in cooler of a container of Cranberry Sauce, the label stated [DATE], when the Dietary Manager was asked when the Cranberry Sauce expired, he/she stated he/she could not find an expiration date and discarded. A third observation made while in the Walk-In Cooler, a case of raw chicken no label to show open date or expiration date, the Dietary Manager located a label from the Vendor that stated, [DATE], when the Dietary Manager was asked when the raw chicken expired, he/she said, Food is discarded after 3 days, which would have been [DATE]. On [DATE] at 8:00 AM during an interview with the CDM regarding labeling and dating. CDM said: We discard after three days of opening and or go by the manufacturer's expiration date for discard of food products. A review of the facility form titled, Dietary Services-Departmental Operations, Dietary Services: Refrigerators and Freezers, states, Policy Statement, The facility will ensure safe refrigerator and freezer maintenance, temperatures, and sanitation, wan will observe food expiration guidelines. Policy Interpretation and Implementation, .7. All food shall be appropriately dated to ensure proper rotation by expiration dates. Received dates (dates of… | 2020-09-01 |
| 1205 | 1205 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2018-04-06 | 814 | D | 0 | 1 | YXGL11 | Based on observations and interviews, the facility failed to ensure the grease trap was placed on concrete surface. Grease receptacle is stored on the grass instead of a concrete surface for 1 of 1 grease trap. The findings included: Grease receptacle stored directly on the soil outside, the dietary manager said s/he contacted grease company to move to solid surface. | 2020-09-01 |
| 1206 | 1206 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2018-04-06 | 865 | D | 0 | 1 | YXGL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interviews, the facility failed to maintain an effective Quality Assurance (QA) program that systematically reviewed food and nutrition services. Expired foods were not discarded and food items were not dated and labeled during the last two recertification surveys. The findings included: During the annual recertification survey conducted from (MONTH) 3, (YEAR) through (MONTH) 6, (YEAR), the kitchen had food items that were not dated and labeled, and expired foods that were not discarded. Cross reference F812-Food and Nutrition Services: the kitchen had food items not dated and labeled, and expired foods that were not discarded. During an interview conducted with the Administrator on [DATE] at 6:32 PM, s/he stated the QA Committee met monthly to discuss issues. It was brought to the Administrator's attention that according to the Centers of Medicare and Medicaid Casper 0003D Provider History Profile, the facility was cited on previous surveys for the issues that were mentioned. | 2020-09-01 |
| 1207 | 1207 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2018-04-06 | 880 | E | 0 | 1 | YXGL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and review of the facility policy titled, Water Management Program to Reduce Legionella, the facility failed ensure the water in high risk areas was tested for Legionella in a timely manner and to act on a positive test on 1 of 2 Halls. The findings included: Review on 4/6/2018 at approximately 2:45 PM of the results from a water test for Legionella, revealed the water was tested on [DATE] and a positive result was reported on 4/3/2018 in the shower head/hose on the Virginia Unit. The results was 12.6. Review on 4/6/2018 at approximately 3:00 PM of the facility policy titled, Water Management Program to Reduce Legionella, states under, Policy Statement, Our facility is committed to the prevention, detection and control of water-borne contaminants, including Legionella. Policy Interpretation and Implementation, number 2 states, The purposes of the water management program are to identify areas in the water system where Legionella bacteria can grow and spread and to reduce the risk of Legionella's Disease. During an interview on 4/6/2018 at approximately 3:10 PM with the Administrator, she was aware of the results but called the testing company to get guidance on making sure the residents were safe. No documentation was found in the facility to ensure the water management team was taking action on the positive results and no further testing was planned. | 2020-09-01 |
| 5078 | 5078 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2016-03-17 | 157 | D | 0 | 1 | 941411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to notify the physician of the test results of 2 stools for occult blood for Resident #51, 1 of 5 residents reviewed for laboratory studies. The findings included: The facility admitted Resident #51 with [DIAGNOSES REDACTED]. At 11:51 AM on 03/16/2016, review of the Telephone Orders revealed an order dated 12/21/15 for Stool for occult blood x (times) 3. At 12:08 PM on 03/16/2016, review of the Medication Administration Records (MARs) revealed the order for the tests was carried over to the (MONTH) MAR and 2 of the 3 ordered tests were signed off on 1/5/16 and 1/6/16. There was no documentation of the results of the tests on the MAR. At 12:11 PM on 03/16/2016, review of the Nurse's Notes revealed no documentation of the test results or that the physician was notified of the results. During an interview on 03/16/2016 at 3:45 PM, the Registered Nurse (RN) Unit Manager confirmed that the results of the 2 tests done in (MONTH) were not documented. S/he also confirmed there was no documentation the MD was notified of the results. At 3:00 PM, after reviewing the record, the RN stated that no documentation could be located of MD notification or why the third specimen was not obtained. | 2019-05-01 |
| 5079 | 5079 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2016-03-17 | 281 | D | 0 | 1 | 941411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and review of the manufacturer's instructions, the facility failed to administer medication using the appropriate technique for 1 of 7 residents. The findings included: During the medication administration observation on 03/16/2016 at 3:15 PM, Licensed Practical Nurse (LPN) #1 was observed administering [MEDICATION NAME] 18 mcg (micrograms) by Handihaler to Resident #51. The LPN opened the [MEDICATION NAME] capsule and emptied the contents into the Handihaler and shook the inhaler. The LPN administered 1 puff to the resident. At 4:05 PM, observation of the [MEDICATION NAME] box revealed no manufacturer's instructions and a copy was requested from the pharmacy. Upon receipt from the pharmacy, review of the manufacturer's instructions revealed The recommended dose of [MEDICATION NAME] HandiHaler is two inhalations of the powder contents of one [MEDICATION NAME] capsule once daily For administration of [MEDICATION NAME] HandiHaler, a [MEDICATION NAME] capsule is placed into the center chamber of the Handihaler device. The [MEDICATION NAME] capsule is pierced by pressing and releasing the green piercing button on the side of the HandiHaler device. During an interview on 03/16/2016 at 4:34 PM, the LPN confirmed the order stated to administer one 18 mcg capsule and that the manufacture instructions indicated that 2 puffs administers the 18 mcg and that the full dose was not administered. | 2019-05-01 |
| 5080 | 5080 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2016-03-17 | 502 | D | 0 | 1 | 941411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to obtain ordered laboratory tests timely for Residents #5 and #51, 2 of 5 residents reviewed for unnecessary medications. The findings included: The facility admitted Resident #51 with [DIAGNOSES REDACTED]. At 11:51 AM on 03/16/2016, review of the Telephone Orders revealed an order dated 12/21/15 for Stool for occult blood x (times) 3. At 12:08 PM on 03/16/2016, review of the Medication Administration Records (MARs) revealed no stool for occult blood was obtained in December. Review of the record of bowel movements revealed the resident was noted to have 10 bowel movements before the first specimen was obtained on 1/5/16. Stool for occult blood was carried over to the (MONTH) MAR and signed off on 1/5/16 and 1/6/16. There was no documentation the third specimen was obtained. Review of the laboratory studies in the record revealed the resident's hemoglobin and hematocrit were low on 12/18/15 resulting in the physician's orders [REDACTED]. At 12:11 PM on 03/16/2016, review of the Nurse's Notes revealed no documentation why the stool specimens ordered 12/21/15 were not done until 1/5 and 1/6/16 or why the third specimen not obtained. There was no documentation of the results of the tests on the MAR or in Nurse's Notes. During an interview on 03/16/2016 3:45 PM, the Registered Nurse (RN) Unit Manager confirmed there was no documentation of a stool for occult blood documented on the MAR (Medication Administration Record) in (MONTH) and that only 2 were documented as obtained on the (MONTH) MAR. The RN further confirmed there was no documentation in the nurses notes why the third specimen was not obtained and that the results of the 2 tests done in (MONTH) were not documented. S/he also confirmed there was no documentation the MD was notified of the results. At 3:00 PM ,after reviewing the record, the RN stated that no documentation could be located of MD notification or why the third speci… | 2019-05-01 |
| 6107 | 6107 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2014-11-13 | 156 | B | 0 | 1 | NM5A11 | Based on record review, interview and review of the facility policy entitled Medicare Part A/Advantage Program, the facility failed to provide 2 of 2 sampled residents reviewed with appropriate generic and liability notices prior to ending Medicare Part A coverage. Residents #4 and #61 were not provided the required Centers for Medicare and Medicaid (CMS) -NOMNC (Notice of Medicare Non-Coverage) or liability notices (CMS or one of the five CMS-approved notices) prior to denial of Medicare Part A services. The findings included: On 11-12-14 at 10 AM, the Administrative Assistant provided a list of 3 residents who had changed from Medicare Part A coverage to other pay sources since 1-1-14 as a result of a facility determination of non-coverage. One of the residents was noted as discharged to the hospital and therefor was not reviewed. During an interview at 3:30 PM on 11-12-14, the Administrative Assistant stated that Resident #4's first non-covered day was 11-7-14. S/he provided a form that was marked as a CMS and a CMS-R-131 Advance Beneficiary Notice of Noncoverage (ABN). An attached form noted that the responsible party was notified of the non-coverage on 9-5-14 and did not request an appeal. ****Denial Letter Only was noted next to the appeal denial. This, then, did not address the expedited appeal rights to the Quality Improvement Organization (QIO) referred to in the CMS- . The Administrative Assistant verified that the CMS NOMNC (Approved 12/31/2011) had not been provided as required. The Administrative Assistant stated that Resident #61's first non-covered day was 7-3-14. S/he provided a form that was marked as a CMS and a CMS-R-131 Advance Beneficiary Notice of Noncoverage (ABN). An attached form noted that the responsible party was notified of the non-coverage on 6-30-14 and did not request an appeal. ****Denial Letter Only was noted next to the appeal denial. This, then, did not address the expedited appeal rights to the Quality Improvement Organization (QIO) referred to in the CMS- . The Administrative… | 2018-05-01 |
| 6108 | 6108 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2014-11-13 | 157 | E | 0 | 1 | NM5A11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interviews and review of Physicians Standing Orders for Elevated Blood Sugars, the facility failed to ensure the physician was notified of elevated blood sugars greater than 450 and missed doses of insulin for 2 of 4 residents reviewed. Resident #7 and #18. The findings included: The facility admitted Resident #7 with a [DIAGNOSES REDACTED]. Review of Resident #7's medical record on 11/12/2014 at approximately 2:57 PM revealed a physician's orders [REDACTED]. Review of Physicians Standing Orders for Elevated Blood Sugars, states, call physician for blood sugars greater than 450. Review of Resident #7's Medication Administration Record [REDACTED]. Further review revealed a recheck of the blood sugar at 10:00 PM of 335. No insulin was documented as given for the blood sugar of 335, and the physician was not notified of the missing dose of insulin which should have been 7 units of [MEDICATION NAME] nor had the physician been notified of the blood sugar of 506 at 8:00 PM. The facility admitted resident #18 with a [DIAGNOSES REDACTED]. Review of Resident #18's medical record on 11/12/2014 at approximately 10:30 AM revealed a physicians order to do Finger Stick Blood Sugars 4 times daily at 6:00 AM, 12:00 Noon, 4:00 PM and 8:00 PM and to give [MEDICATION NAME] Insulin via a sliding scale. If blood sugars are greater than 450 give 10 units of [MEDICATION NAME] Insulin and to recheck blood sugars in 2 hours and follow the sliding scale. Review of Physicians Standing Orders for Elevated Blood Sugars, states, call physician for blood sugars greater than 450. Review of Resident #18's MARs on 11/12/2014 at approximately 10:33 AM revealed a MAR indicated [REDACTED]. The fingerstick blood sugar was not rechecked on either day. Review of the MARs dated July 2014 on 11/12/2014 at approximately 10:40 AM revealed a blood sugar of 486 on the 4th at 11:00 AM, 494 on the 8th at 11:00 AM, 454 on the 11th at 8:00 PM, 490 on the 16th at 7:00 … | 2018-05-01 |
| 6109 | 6109 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2014-11-13 | 159 | F | 0 | 1 | NM5A11 | Based on record review and interview, the facility failed to follow general accounting principles for 4 of 4 residents reviewed (Resident Record #1771, #1637, #1667, and #1544). Deposits and withdrawals were not posted to residents' accounts in a timely manner. Monies were deducted from the Resident Trust Account without specific authorization. Disbursements did not indicate items purchased and were not witnessed appropriately. Receipts of items were not authorized by individual residents. In addition, quarterly statements were not provided to one of three residents reviewed. (Resident #15) No authorizations were noted for specific recurring deductions such as room and board (one of one resident reviewed with a recurring liability, of a total of 4 residents reviewed with a Resident Trust account-Resident Record #1771). The findings included: On 11-10-14 at 2:34 PM, Resident #15 stated the facility managed her/his personal funds but that s/he was not aware of how much money was in the account. During an interview beginning at 2 PM on 11-12-14, the Social Services Director (SSD) (identified as Resident Trust Fund account manager) provided requested evidence of quarterly statements being sent/given to residents (or legal representatives) whose funds were being managed by the facility. A sheet of tablet paper entitled Resident Funds Statements 7-1-14 9-30-14 (handwritten) with resident signatures was provided. There were 15 residents' names on the form who had signed with an x. There were 2 signatures of staff members at the top of the form, but each X was not witnessed by two individuals. There were no dates to indicate when the statements had been provided to the residents. Review of the form with the SSD revealed that Resident #15 had not signed the form to indicate s/he had received the quarterly statement as required. The SSD noted, I did miss her. Interview and further review of the Resident Trust Fund accounting with the SSD on 11-12-14 revealed the following: (1) Deposits were not posted to residents' account… | 2018-05-01 |
| 6110 | 6110 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2014-11-13 | 253 | E | 0 | 1 | NM5A11 | Based on observation and interview the facility failed to provide housekeeping and maintenance services to ensure residents overbed tables were maintained and in good repair, resident toilet on the Virginia unit had a crack at the base and was loose, the microwave in the dining room was observed with food splatters on sides and top and all dining room tables wheels were observed not locking causing the tables to be unstable. The concerns were identified on 2 of 2 units (Victoria and Virginia). The facility also failed to eliminate environmental hazards within the facility's interior area that are used by ambulatory residents. Resident bathrooms in rooms 102, 103, 104 and 106 were observed with an elevated surface of approximately 1 inch in height. The findings include: Observations were made on 11/11/14 at approximately 11:35 AM, the following rooms overbed table's outer trim molding was chipped off around the entire surface, exposed particle board, sharp corners, bubbling and the base of the table had dirt debris in rooms: 202, 203, 206, 208, 209 210 and room 106. Observation of dining services in the main dining room on 11/11/14 at approximately 12:00 PM the surveyor observed all the tables were unstable. The surveyor observed a random Certified Nursing Assistant place a resident to the table and the table rolled. Further observation of the dining room revealed multiple food splatters and debris in the microwave. Observation on 11/11/14 at approximately 2:30 PM revealed the Virginia unit restroom's toilet commode with a crack at its base and loose from the floor. During an interview with Housekeeping Supervisor and the Maintenance Director on 11/12/14 at approximately 4:15 PM, they confirmed the surveyor's findings. The Maintenance Director stated that the overbed tables should be replaced and confirmed that the wheels on the dining room table needed to be replaced so that the table would not slide. The Housekeeping Supervisor stated that the microwave was suppose to be cleaned every shift. No cleaning schedule… | 2018-05-01 |
| 6111 | 6111 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2014-11-13 | 282 | E | 0 | 1 | NM5A11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interviews the facility failed to follow the care plan to provide range of motion and splinting for one of three residents reviewed for range of motion (ROM) (Resident #6). For Resident #49, one of one resident reviewed with a urinary catheter, based on record review and interview, the facility failed to follow the care plan related to monitoring intake and output. In addition, based on observation, record review, and interview, the facility failed to follow the care plan to ensure alarm function for one (Resident #35) of four sampled residents reviewed for falls. The findings included: The facility admitted Resident #6 with [DIAGNOSES REDACTED]. During an observation and interview on 11/10/2014 at 11:24 AM, Resident #6 was noted with contractures of both upper extremities. S/he was unable to straighten the left hand or elbow upon command. No handrolls or splint devices were observed in place at any time during the survey. Record review on 11-11-14 at 12:09 PM revealed a Physician's Order for Bilat(eral) palm protector @ bedtime as needed. Nurse to check placement and correct application. Review of the Care Plan on 11-11-14 at 1:48 PM revealed a problem/need for Res(ident) requires total assist with most ADL's R/T (related to) advanced age, impaired mobility D/T (due to) bil(ateral) AKA (above knee amputation) and cognitive deficits with dx. (diagnosis) of dementia and hx. (history) of [MEDICAL CONDITION]. Approaches included: Provide passive/active ROM daily during care as res(ident) tolerates, 4/10/14* Bil. palm protectors at bedtime PRN as ordered and 6/17/14 *Nurse to check placement and correct application q. (every) shift, bil. palm protectors. Review of the Treatment Sheets for 6/14 through 11/14 revealed no initials to indicate that the splints had been applied since at least 6-17-14. Review of ADL (Activities of Daily Living) forms at 12:42 PM on 11-11-14 revealed that both ROM and application… | 2018-05-01 |
| 6112 | 6112 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2014-11-13 | 309 | E | 0 | 1 | NM5A11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, and interview the facility failed to monitor finger-stick blood sugars (FSBS) as ordered for 1 of 4 sampled residents reviewed with physician orders for sliding scale insulin. Staff failed to recheck blood sugars greater that 450mg% for Resident #18. Also, based on observations, record review and interview, there was no evidence of routine monitoring to assure patency of a urinary catheter for one of one sampled resident reviewed with a catheter in place. (Resident #49) The findings included: Record review on 11-11-14 at 2:31 PM revealed that Resident #49 was admitted with [DIAGNOSES REDACTED]. Daily medications included UTI Stat, Cranberry Extract, and [MEDICATION NAME]. Review of the 8-7-14 Annual Minimum Data Set (MDS) Assessment on 11-11-14 at 930 PM revealed that the resident had a Brief Interview for Mental Status score of 3, indicating severe cognitive impairment. S/he had one healing stage 4 pressure ulcer. Observations on 11-10-14 and 11-11-14 revealed that the resident had a suprapubic (SP) catheter in place. S/he was noted to be restless, calling out to passersby, with the abdomen, catheter, and [MEDICAL CONDITION] exposed. Review of Incident/ Accident Reports at 10 AM on 11-12-14 revealed that Resident #49 had had the SP catheter pulled out/dislodged four times during the review period (on 4-27-14, 4-30-14, 5-17-14, and 5-28-14). At least three of the four times, the resident was sent to the emergency room to have it replaced. Review of Physician's Orders and lab reports on 11-11-14 at 3:14 PM revealed that the resident had been treated for [REDACTED]. Physician's Orders included toencourage fluids. Review of the ADL (Activities of Daily Living) Sheets (Certified Nursing Assistant Care Plan) on 11-12-14 at 10:24 AM revealed that the resident's catheter was noted as FYI (for your information). There was no instruction on the form to encourage fluids. Review of the interdisciplinary Care Plan on 11-12-14 at 1… | 2018-05-01 |
| 6113 | 6113 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2014-11-13 | 318 | E | 0 | 1 | NM5A11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to provide range of motion (ROM) services as needed and splinting as ordered to prevent further decline for one of three residents reviewed for ROM. There was no evidence that staff provided ROM or applied splints as ordered for Resident #6. The findings included: The facility admitted Resident #6 with [DIAGNOSES REDACTED]. The resident was noted by two physicians as unable to make health care decisions. During an observation and interview on 11/10/2014 at 11:24 AM, Resident #6 was noted with contractures of both upper extremities. S/he was unable to straighten the left hand or elbow upon command. No handrolls or splint devices were observed in place at any time during the survey. At 11:45 AM on 11-10-14, contractures of both hands were confirmed during the Staff Interview with the Director of Nurses (DON). Record review on 11-11-14 at 12:09 PM revealed a physician's orders [REDACTED].@ bedtime as needed. Nurse to check placement and correct application. Review of the Treatment Sheets for 6/14 through 11/14 revealed no initials to indicate that the splints had been applied since at least 6-17-14. Review of 9-8-14, 10-8-14, and 11-8-14 Monthly Summaries on 11-11-14 at 12:22 PM revealed no mention of use/refusal of the palm protectors. Review of Nurse's Notes 6-14 through the dates of the survey also revealed no evidence of use/refusal of the palm protectors. Review of ADL (Activities of Daily Living) forms at 12:42 PM on 11-11-14 revealed that both ROM and application of palm protectors were documented for months prior to 9-14. ADL forms for 9-14, 10-14, and 11-14 noted FYI (for your information) in the column marked time codes (completion times). There were no initials to indicate that ROM had been done with the resident or that palm protectors had been applied as ordered. During an interview on 11-11-14 at 1:05 PM, when asked how staff determined if a resident had had a decline in RO… | 2018-05-01 |
| 6114 | 6114 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2014-11-13 | 333 | D | 0 | 1 | NM5A11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to ensure 2 of 7 residents were free of significant medication errors. Resident #7 and #18 did not receive [MEDICATION NAME] Insulin for elevated blood sugars. The findings included: The facility admitted Resident #7 with a [DIAGNOSES REDACTED]. Review of Resident #7's Medication Administration Record [REDACTED]. The facility admitted Resident #18 with [DIAGNOSES REDACTED]. Review of Resident #18's MAR indicated [REDACTED]. He/she did not receive the ordered insulin coverage. Further review of Resident #18's MAR indicated [REDACTED]. He/she did not receive the ordered insulin coverage. An interview with Registered Nurse (RN) #1 on 11/12/2014 at approximately 3:33 PM, he/she stated, I would give insulin coverage according to the sliding scale if the blood sugar remained elevated after the 2 hour recheck. An interview on 11/12/2014 at approximately 3:56 PM with the Director of Nursing (DON), he/she stated, I would expect the nurses to follow the sliding scale for insulin if the blood sugar remained elevated after the recheck. | 2018-05-01 |
| 6115 | 6115 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2014-11-13 | 371 | F | 0 | 1 | NM5A11 | Based on observations, interview and review of the facility policies titled Dietary Policy and Procedure the facility failed to ensure the sanitizer buckets registered between 150-200 parts per million (ppm) and ensure the ice machine filter was free from dust and debris. This had the potential to effect all residents in the facility who received food by mouth. The facility also failed to distribute food under sanitary conditions to multiple residents on 1 of 2 halls. The findings included: Review of the facility policy titled Dietary Policy and Procedure no revision date noted: Dietary surfaces are washed and sanitized with detergent and hot water, rinsed, air dried and sprayed with sanitizing solution at the effective concentration Cleaning cloths are placed in a chemical sanitizing solution of appropriate concentration. The chemical sanitizing solution is used according to manufacturers instructions. If explicit instructions are not provided by the manufacturer the recommended sanitization concentrations are as follows: Quaternary 150-200 ppm concentration contact time per manufacturers instructions. During an initial tour of the facility kitchen on 11/10/14 at approximately 10:19 AM, revealed an observation of the chemical sanitizer which was stored in a red bucket. The surveyor had dietary staff check the concentration of the sanitizer which revealed no evidence of sanitizer as it registered 0 ppm. The dietary staff confirmed the test strip did not meet the required ppm. S/he further stated the sanitizer was just changed and that it is changed twice each shift. Further observation of the kitchen revealed a heavy build up of dust and debris on the filter cover of the ice machine. Observation in the kitchen on 11/12/14 at approximately 11:09 AM, the surveyor had the staff to check the concentration of the sanitizer in the red bucket. Review of the test strip revealed the sanitizer registered at 0 ppm. The Dietary Manager confirmed the surveyor's findings. The ice machine's filter was once again observed with a… | 2018-05-01 |
| 6116 | 6116 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2014-11-13 | 502 | D | 0 | 1 | NM5A11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to obtain laboratory results and/or obtain them in a timely manner for one of five residents reviewed for unnecessary medications. [MEDICATION NAME] levels were not done as ordered to monitor medication levels and culture results were not reported and/or addressed in a timely manner resulting in delay of treatment for two Urinary Tract Infections [MEDICAL CONDITION] for Resident #49. The findings included: The facility admitted Resident #49 with [DIAGNOSES REDACTED]. Record review on 11-11-14 at 2:49 PM revealed 10-7-14 physician's orders [REDACTED].@ HS (hour of sleep). Additional changes in [MEDICATION NAME] dosage had been made on 9-3-14 and 9-29-14. The resident was also on daily medications of [MEDICATION NAME] ER, [MEDICATION NAME], and received [MEDICATION NAME] on an 'as needed' basis. Review of Nurses Notes on 11-12-14 at 11:07 AM revealed that Resident #49 exhibited multiple self destructive and verbal behaviors. A 11-5-14 Psychiatric Consult noted severe behavioral issues for which medication changes were again planned. A 11-5-14 physician's orders [REDACTED]. At 3:14 PM on 11-11-14, no results could be located on the record by the Director of nurses (DON) for the Free [MEDICATION NAME] level. S/he nor the consultant were familiar with the lab test. On 11-11-14 at 6 PM, the DON, in the presence of the consultant, stated that the facility's contracted lab did not know about two different tests for [MEDICATION NAME] acid levels and thought it was only one result. The DON called the Psychiatrist who had written the order to explain the two different levels. When asked about the lab process, the DON stated that computerized lab requisitions were completed and the Unit Manager was responsible for ensuring that the labs were drawn and reports returned in a timely manner. During an interview on 11-12-14 at 1:58 PM, the DON supplied a copy of the requisition and stated,The Ward Secr… | 2018-05-01 |
| 7341 | 7341 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2013-06-06 | 166 | E | 0 | 1 | 43K911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review, observation, interview and review of the Social Services job description, the facility failed to have a system in place to record, investigate and assure prompt resolution of grievances. The findings included: On 6/6/13 at 2:22 PM, an interview was conducted with the Social Services Director (SSD) related to the facility policy and procedure for handling resident grievances. The SSD explained that if a resident came to him/her with a concern, s/he relays the concern to the Unit Manager and or the Director of Nursing. The concern is not documented nor is the resolution of the concern. The SSD further explained at his/her previous job s/he had a log but there is not one here at this facility. When asked where the forms were located if a resident wished to submit a grievance in writing, s/he stated s/he did not know. A discussion with the SSD, Administrator and this Surveyor resulted in the SSD being informed that the SSD was responsible for grievances and it was listed in his/her job description. The SSD stated s/he did not have a log or copies of a grievance form and s/he was advised by the Administrator to call the former Social Worker for further information. A copy of the SSD job description was requested from the Administrator and the job description included review departmental grievances from personnel, written report to Administrator of actions taken, follow facility established procedures and was signed by the SSD on 8/24/12. A performance evaluation conducted on 12/12 indicated no concerns and did not identify the lack of written grievances. During an interview with the Unit Manager ( who has been employed for greater than [AGE] years at the facility) at 2:50 PM, when asked what s/he would do if a resident complained of missing money/care concern, s/he stated they would look for it and or investigate. When asked if it would be documented on a grievance form, s/he stated no. When asked… | 2017-03-01 |
| 7342 | 7342 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2013-06-06 | 221 | E | 0 | 1 | 43K911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review, observation, interview and review of the facility provided policy for restraints, the facility failed to assess Resident # 51 for the least restrictive device; failed to apply a clip, soft belt restraint appropriately; used leg restraints with with a Broda chair without a physicians order; and failed to promptly identify and provide intervention for documented risks associated with restraint use. (1 of 3 sampled residents reviewed for restraints) Cross refer to F 272 as it relates to the failure to complete assessments for all restrictive devices used and failure to to accurately complete a siderail assessment. Cross refer to F-280 as it related to the failure of the facility to include all the restrictive devices used for the resident in the resident's plan of care and failure to include all recommended actions to prevent reoccurrence in the plan of care. Cross refer to F 323 related to the failure of the facility to identify the hazards associated with restraint use. The findings included: On 6/5/13 at 8:15 AM, Resident # 51 was observed in his/her room seated in a wheelchair next to the bed. A soiled clip, soft belt was around the resident's waist, clipped in the back and one string of the restraint was securely tied to the right rear anti-tip bar in the rear of the chair. A Certified Nursing Assistant (CNA) was observed as s/he transferred the resident without assistance from the wheelchair to the bathroom, from the bathroom to the wheelchair and reapplied the restraint in the same manner. At approximately 8:30 AM, the resident was observed in the dining room area. The soiled, clip, soft belt remained clipped in the back of the chair and tied to the anti-tip bar. Following the observation, an interview was conducted with the Unit Manager and the Minimum Data Set Coordinator as to how a CNA would know the level of care a resident required and the individual needs of a resident. It was expl… | 2017-03-01 |
| 7343 | 7343 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2013-06-06 | 253 | E | 0 | 1 | 43K911 | On the days of the survey, based on random observations and interviews, the facility failed to provide necessary housekeeping and maintenance services to maintain a sanitary, orderly, and comfortable interior on 2 of 2 units. There were multiple concerns related to chair armpads, window sills, privacy curtains, furniture, and ceiling vents. The findings included: During the Initial Tour of the facility on 06-04-13 at approximately 7:15 AM and all days of the survey, random observations revealed the following: 1. Multiple privacy curtains throughout the facility were noted without curtain hooks: Room # 100, 101, 106, and 204, 2. Room #104 A: Black cord from the TV to the antenna draped near the wall. 3. Room #105 A: Black cord from the TV to the antenna draped downward in front of the curtain. 4. Room #201: Clock inside the room above the doorway noted to have the wrong time; long hand of the clock did not move forward. Wheelchair noted with cracked armpads on both sides. 5. Room #202 B: Bedside cabinet scuffed 6. Room #202 C: Wheelchair noted with a torn armpad 7. Room #204 B: Bedside cabinet with dried white liquid present on the front and Geri-recliner with tears noted at the end of the right and left armpads. 8. Room #206 A: Call bell in shared bathroom non-functioning. 9. 200 Hallway: 1) One brown geri-chair noted with dark stains in the seat, and the seat, left armpad, and left upper back areas noted with torn areas. 2) One green geri-chair noted with torn areas on the left and right armpads. 3) Heavy build-up of gray matter in the ceiling vent in the hall outside C BR (Bathroom). 10. Dining Room: Three window sills noted with chipped paint. During a walking tour on 06-06-13 at approximately 3:30 PM, in the presence of the Maintenance Director, he/she verified the above findings. The Maintenance Director revealed he/she had not been responsible for the cleaning of the furniture and would notify housekeeping personnel of issues identified. During the Initial Tour of the 100 Hall on 6-4-13 at approximately 6:5… | 2017-03-01 |
| 7344 | 7344 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2013-06-06 | 279 | E | 0 | 1 | 43K911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interview, the facility failed to develop individualized plans of care including interventions to address exhibited behaviors prior to administration of psychoactive medication for two of eleven residents reviewed for unnecessary medications. The Care Plan for Resident #6 did not include specific individualized non-pharmacological interventions to be attempted prior to administration of IM (intramuscular) [MEDICATION NAME]. There was no Care Plan developed for the use of psychoactive medications for Resident #57. The facility also failed to develop a Care Plan to meet the needs of one of four residents reviewed for falls (Resident #13). The findings included: The facility admitted Resident #6 with [DIAGNOSES REDACTED]. Review of the 4-23-13 Annual Minimum Data Set (MDS) Assessment on 6-5-13 at 9 PM revealed that Resident #6 had a Brief Interview for Mental Status (BIMS) score of 2, indicating severe cognitive impairment. S/he had unclear speech, was sometimes understood and sometimes understands. The only behavior noted was inattention. S/he required moderate assistance with dressing and extensive assistance with transfers and toileting. Eating and locomotion required only supervision. No impairments in ROM (range of motion) were noted. S/he was incontinent of bowel and bladder. Resident #6 had an unsteady balance and was noted as having 2 or more falls since the prior assessment. Section N of the MDS noted that the resident had received antianxiety and antidepressant medication daily during the 7 day lookback period. No restraints were coded as in use. the resident's family participated in the MDS and noted that personal belongings, choices in daily activities, snacks, going outside, family, and religion were important to the resident. Review of Nurse's Notes on 6-5-13 at 12:20 PM revealed that on 3-4-13 at 7 PM, following a joyride via van, Resident #6 experienced increased agitation,att… | 2017-03-01 |
| 7345 | 7345 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2013-06-06 | 281 | E | 0 | 1 | 43K911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review, interview, review of the facility provided policy related to changing Gastrostomy tubes, a facility Licensed Practical Nurse documented changing Resident 51's gastrostomy tube while lacking knowledge of the actual date of insertion and having no documented evidence of required training for the insertion of gastric tubes. The findings included: Resident # 51 was admitted to the facility on [DATE]. The initial nursing documentation stated: Res(resident) does have a 16 fr (French) PEG (percutaneous gastrostomy or feeding tube) tube to abdomen, to the right side of the peg insertion site is a surgical cap or button . On 12/22/12 at 11:15 AM, nursing documented the resident pulled the gastric tube out at 9:30 AM. Nurse had to have staff replace tube with # 14 fr 6 cc (cubic centimeter) balloon. Placement checked and confirmed via auscultation and aspiration. The nursing note was signed by a Licensed Practical Nurse. There was no documentation of the changing of the gastric tube documented on the treatment record for December. On 2/1/13 (44 days later) an inserted nurses note with no other documentation on either side stated: (addendum to note written on 12-22-12 at 11:15 A) Nurse had staff assist nurse in changing [DEVICE] (gastrostomy tube). Nurse had also spoken with Dr. XXX at 9:40 AM and made MD aware that resident pulled [DEVICE] out and MD gave order to place [DEVICE] back in. Nurse then replaced [DEVICE] with 14 fr. Placement checked and confirmed by auscultation and aspiration with no residual. XXX, RN (registered Nurse) also checked placement via auscultation and aspiration with placement confirmed. This entry was signed by the same LPN who wrote the original note. On 6/6/13 at 10:15AM, the facility consultant and unit manager were asked to identify the date the gastric tube was originally inserted. After reviewing the medical record, the information could not be located and the transferr… | 2017-03-01 |
| 7346 | 7346 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2013-06-06 | 282 | G | 0 | 1 | 43K911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interview, the facility failed to provide fall prevention measures as ordered and care planned for Resident # 57 including a self releasing seatbelt and a chair/bed alarm. The facility also failed to follow the plan of care for Resident # 51 related to leaving the resident unattended in the bathroom, the resident was observed in his/her room without a call light in reach, without a chair/bed alarm in place and with a bed mat alarm that was turned to silence mode. Resident 6 was observed without physician ordered safety devices in place. (3 of 4 sampled residents reviewed for careplans related to falls) The findings included: . Record review revealed Resident 51's careplan stated the resident was to wear bed/chair alarm when out of bed to the wheelchair at all times (page 8 of 16) . The plan of care also stated to encourage resident to remain in supervised areas when out of room. (page 6 of 16). Additionally, incident accident reports included additional steps to be taken to prevent reoccurrence of falls and these included: Resident to be in staff presence when up in chair. (3/16/13) On 6/5/13 Resident # 51 was observed seated in a wheelchair in the dining area with no bed/chair alarm attached. On 6/6/13 at 10 AM, the resident was observed in his/her room, the call bell was in the resident wheelchair that was out of the residents reach. The bed/chair alarm was still attached to the wheelchair. Resident # 51 was awake, reaching for the wheelchair but unable to reach it. A bed mat alarm was observed under the resident. A CNA working in the room was notified that the resident was awake and reaching for the wheelchair. S/he was unable to visualize the resident because the bedside curtains were pulled around the resident. CNA # 1 verified the call bell was out of reach for the resident and that the bed/chair alarm was attached to the wheelchair. The CNA was unsure if the resident needed the bed/… | 2017-03-01 |
| 7347 | 7347 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2013-06-06 | 309 | E | 0 | 1 | 43K911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on interviews and record review, the facility failed to coordinate services related to Hospice care for 1 of 1 residents reviewed.(Resident #2) The findings included: The facility admitted Resident #2 with [DIAGNOSES REDACTED]. Record review on 6/5/13 revealed Resident #2 was placed on Hospice care on 1/21/13. Further review of the record revealed that there was a Hospice care plan dated 3/20/13 located on the chart. An area was checked that the care plan was reviewed with the Nursing Home staff. No facility staff signature was observed on the care plan. No current Hospice care plan was noted on the chart. Review of the facility care plan revealed no documentation that Hospice attended and/or reviewed the facility care plan. Review of the discipline notes revealed the last documented Hospice Nurse's Notes were dated 1/19/13. No current Hospice Nurse's notes were available in the facility. The last documentation of the Hospice Aide was 4/12/13. An interview with the Care Plan Coordinator on 6/6/13 confirmed that the chart lacked documentation of collaboration between Hospice and the facility related to the resident's care. An interview with the Chief Operating Officer(COO) of the facility on 6/6/13 confirmed that complete and current Hospice information was not on the resident's record. A request was made for the current Hospice information by the COO. No new Hospice information was sent to the facility. | 2017-03-01 |
| 7348 | 7348 | WINDSOR MANOR | 425114 | 5583 SUMMERTON HIGHWAY | MANNING | SC | 29102 | 2013-06-06 | 318 | D | 0 | 1 | 43K911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observations, record review, and interview, the facility failed to provide appropriate treatment and services to increase range of motion and/or to prevent further decrease in range of motion for 1 of 3 residents reviewed. Resident #29 did not have a palmer cushion applied as ordered. The findings included: The facility admitted Resident #29 with [DIAGNOSES REDACTED]. Review of the current physician orders [REDACTED]. Review of the Treatment Sheet for June 2013 revealed the nurses had signed the treatment sheet indicating that the resident was wearing the right palmer splint. Review of an Occupational Therapy Screen dated 5/14/13 indicated that the right progressive palm protector was still appropriate. Observation of the resident on 6/3/13 at 10:37 AM, 3:35 PM ; 6/5/13 at 8:37 AM; and 6/6/13 at 3:20 PM revealed the palmer splint had not been placed on the resident. This was confirmed by the Unit Manager on 6/6/13 at 3:20 PM. | 2017-03-01 |
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CREATE TABLE [cms_SC] ( [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 );