CMS-Nursing-Home-Full-Deficiencies

In collaboration with The Seattle Times, Big Local News is providing full-text nursing home deficiencies from Centers for Medicare & Medicaid Services (CMS). These files contain the full narrative details of each nursing home deficiency cited regulators. The files include deficiencies from Standard Surveys (routine inspections) and from Complaint Surveys. Complete data begins January 2011 (although some earlier inspections do show up). Individual states are provides as CSV files. A very large (4.5GB) national file is also provided as a zipped archive. New data will be updated on a monthly basis. For additional documentation, please see the README.

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rowidfacility_namefacility_idaddresscitystatezipinspection_datedeficiency_tagscope_severitycomplaintstandardeventidinspection_textfiledate
6256 MAGNOLIA MANOR - GREENVILLE 425090 411 ANSEL ST GREENVILLE SC 29601 2014-06-19 156 C 0 1 336311 On the days of the survey, based on Liability Notices and Beneficiary Appeal Rights form review and interview, the facility failed to use the correct mandated form for Notice of Medicare Provider Non-Coverage (NOMNC) for 3 of 3 residents reviewed. The findings included: On 06/18/14 at approximately 10:00 AM, during the review of liability notices issued by the facility, it was revealed that the facility was using the form instead of the updated NOMNC form. Interview with the Business Office Manager at the time of the findings confirmed that the updated NOMNC forms were not being used and he/she was unaware the form had been updated. 2018-04-01
6257 MAGNOLIA MANOR - GREENVILLE 425090 411 ANSEL ST GREENVILLE SC 29601 2014-06-19 157 D 0 1 336311 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the recertification survey, based on record review and interview, the facility failed to notify the physician and interested family member of changes in the resident's condition requiring potential physician intervention for 1 of 11 sampled residents reviewed for notification. There was no evidence that the physician and/or family were notified of Resident #9 pocketing/hoarding medication. The findings included: The facility admitted Resident #9 to the facility with [DIAGNOSES REDACTED]. On 6/17/2014 at approximately 11:30 AM, record review of the 2-25-14 Nurse's Notes revealed that Resident #9 was pocketing her/his narcotic medication by using her/his tongue to tuck the pill in her/his bottom lip and on the side of her/his mouth until the nurse walked out of the room. During an interview on 6-17-14 at 5 PM, Licensed Practical Nurse (LPN) #3 confirmed the incident and stated, I took the medication into the resident's room mixed in applesauce because I had heard that she (he) was pocketing her (his) medication and a pill was found at the bedside. (Resident #9) refused to take the medication mixed in the applesauce. LPN #3 reviewed the Nurse's Notes and confirmed that there was no documentation about notifying the physician or the responsible party of the incident. On 6/17/2014 at approximately 11:40 AM, interview with the Unit Manager of the West Wing revealed s/he was not aware of the incident. On 6/17/2014 at approximately 12:10 PM, interview with the Social Services Director revealed s/he was not aware of the incident. 2018-04-01
6258 MAGNOLIA MANOR - GREENVILLE 425090 411 ANSEL ST GREENVILLE SC 29601 2014-06-19 274 D 0 1 336311 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification Survey, based on record reviews, interviews, and review of CMS's (Centers for Medicare & Medicaid Services) RAI (Resident Assessment Instrument) Version 3.0 Manual, the facility failed to conduct Significant Change in Status Assessments for Residents #4, #6, and #10, 3 of 3 residents reviewed with a significant change in status. The findings included: The facility admitted Resident #4 with [DIAGNOSES REDACTED]. On 6/17/14 at 2:34 PM, review of the Annual MDS (Minimal Data Set) dated 6/3/14 revealed Resident # 4 was coded as requiring extensive assistance with bed mobility, transfers and locomotion on and off the unit and for eating. Comparison to the previous Quarterly MDS assessment dated [DATE] indicated the resident had been coded as limited assistance for these aspects of ADLs (Activities of Daily Living) indicating the resident had experienced a decline. Further review revealed the resident had also experienced a decline in urinary and bowel continence and was newly coded as always incontinent where he/she had previously been coded as frequently incontinent. In addition, Resident #4 was coded as having verbal behaviors 1-3 days during the assessment period and other behaviors daily and had an unstageable pressure ulcer that were not present on the previous assessment. Review of the record revealed the resident's behaviors had began in April, 2014 and the Pressure ulcer onset date was 5/2/14. The facility admitted Resident #6 with [DIAGNOSES REDACTED]. On 6/17/14 at 3:00 PM, review of the Annual MDS (Minimal Data Set) dated 2/6/14 revealed Resident #4 was coded as requiring limited assistance with bed mobility. In addition, the resident was coded as having a poor appetite or overeating on 2-6 days during the assessment period resulting in a mood severity score of 1. Comparison to Quarterly MDS assessment dated [DATE] indicated the resident was newly coded as requiring extensive assistance for bed mobility and was coded as having an increase in the number and frequency of mood indicators resulting in a mood severity score of 5. Further review revealed the resident was coded as having a significant weight loss on the 5/8/14 quarterly assessment. During an interview on 6/18/14 at 9:10 AM, the MDS Coordinator confirmed the MDS dated [DATE] indicated Resident #4 had had a decline in behaviors, ADLs, urinary continence and a new pressure ulcer and verified that a Significant Change in Status Assessment (SCSA) should have been conducted in May, 2014. The MDS Coordinator also confirmed the decline in bed mobility and mood and the significant weight loss for Resident #6 and verified that a SCSA should have been done. A review of CMS's RAI Version 3.0 Manual, Chapter 2, page 2-20 revealed The SCSA (Significant Change in Status Assessment) is a comprehensive assessment for a resident that must be completed when the IDT (Interdisciplinary Team) has determined that a resident meets the significant change guidelines for either improvement or decline. In addition, the manual indicated, page 2-24, a SCSA would be appropriate for a Decline in two or more of the following: Resident ' s decision-making changes; Presence of a resident mood item not previously reported by the resident or staff and/or an increase in the symptom frequency; Increase in the number of areas where behavioral symptoms are coded as being present and/or the frequency of a symptom increases for items in Section E (behavior); Any decline in an ADL physical functioning area where a resident is newly coded as Extensive assistance, Total dependence, or Activity did not occur since last assessment; Resident ' s incontinence pattern changes or there was placement of an indwelling catheter; Emergence of unplanned weight loss problem (5% change in 30 days or 10% change in 180 days); Emergence of a new pressure ulcer at Stage II or higher or worsening in pressure ulcer status; Resident begins to use trunk restraint or a chair that prevents rising when it was not used before; and/or Overall deterioration of resident ' s condition. On 06/18/14 at approximately 9:00 AM, Resident #10's annual Minimum Data Set ((MDS) dated [DATE], documented that the resident showed an improvement after receiving therapy. The MDS quarterly dated 05/08/14 showed a decline from a 2 (improvement) to a 3 (decline) in both of the dressing and hygiene/bathing areas. Interview with the MDS coordinator at the time of findings verified that no significant change had been done as required. 2018-04-01
6259 MAGNOLIA MANOR - GREENVILLE 425090 411 ANSEL ST GREENVILLE SC 29601 2014-06-19 278 D 0 1 336311 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of Recertification Survey, based on record review and interview, the facility failed to accurately assess Residents #4 and #6, 2 of 11 sampled residents reviewed for assessments. The facility failed to interview the residents for cognition and mood despite the fact the residents were not coded as rarely or never understood. The findings included: The facility admitted Resident #4 with [DIAGNOSES REDACTED]. On 6/17/14 at 2:01 PM, review of the Annual Minimal Data Set ((MDS) dated [DATE] revealed Resident #4 was coded as usually understands and usually understood in Section B for for Hearing, Speech, and Vision. Section C, Cognitive Patterns, C0100, Should Brief Interview for Mental Status be Conducted, was coded 0 No (resident is rarely/never understood). Section C0600, Should the Staff Assessment for Mental Status be Conducted, was not coded but a Staff Assessment was conducted that coded the resident as severely impaired, rarely/never made decisions. Further review revealed Section D of the MDS for Mood, D0100, Should Resident Mood Interview be Conducted, was also coded 0 No (resident rarely/never understood and a Staff Assessment of Resident Mood was conducted. There was no indication that the facility attempted to interview the resident for cognition of mood indicators. The facility admitted Resident #6 with [DIAGNOSES REDACTED]. On 6/18/14 at 3:00 PM review of the Annual Minimal Data Set ((MDS) dated [DATE] revealed Resident #6 was coded as usually understands and usually understood in Section B for for Hearing, Speech, and Vision. Section C, Cognitive Patterns, C0100, Should Brief Interview for Mental Status be Conducted, was coded 0 No (resident is rarely/never understood). Section C0600, Should the Staff Assessment for Mental Status be Conducted, was not coded but a Staff Assessment was conducted that coded the resident as severely impaired, rarely/never made decisions. Further review revealed Section D of the MDS for Mood, D0100, Should Resident Mood Interview be Conducted, was also coded 0 No (resident rarely/never understood and a Staff Assessment of Resident Mood was conducted. During an interview on 6/18/14 at approximately 9:15 AM, the Social Services Director (SSD) confirmed that s/he did not conduct resident interviews for Resident #4 and #6. The SSD stated that s/he used the information from the monthly nursing summary to code the MDS. The MDS Coordinator, also present during the interview, confirmed an interview should have been attempted and coded accordingly. 2018-04-01
6260 MAGNOLIA MANOR - GREENVILLE 425090 411 ANSEL ST GREENVILLE SC 29601 2014-06-19 280 D 0 1 336311 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification survey, based on record review and interview, the facility failed to update the care plan for 1 of 3 residents reviewed for careplan's related to behaviors. The care plan was not updated for Resident #9 who had an onset of a previously unidentified behavior of pocketing/hoarding medication. The care plan was also not updated for 1 of 1 sampled residents reviewed for falls. The findings included: The facility admitted Resident #9 to the facility with [DIAGNOSES REDACTED]. Record review on 6/17/2014 at approximately 11:30 AM revealed an entry in the Nurse's Notes dated 2-25-14 at 11:45 PM which stated: Resident has been allegedly pocketing her (his) narcs (narcotics) . On 2-26-14 at 2:45 AM, .Resident admitted to this nurse she (he) has been hoarding her (his) narcs. Resident demonstrated .how she (he) uses her (his) tongue to tuck the pill in her (his) bottom lip or on the side of her (his) mouth until nursing staff walks out of her (his) room. Record review revealed that the Care Plan had not been updated to reflect the new behavior and no new interventions had been added. On 6/17/2014 at approximately 11:40 AM, interview with the Unit Manager of the West Wing revealed s/he was not aware of the incident. On 6/17/2014 at approximately 12:10 PM, interview with the Social Services Director revealed s/he was not aware of the incident and that the care plan had not been updated for this new behavior of pocketing medication. 2018-04-01
6261 MAGNOLIA MANOR - GREENVILLE 425090 411 ANSEL ST GREENVILLE SC 29601 2014-06-19 282 D 0 1 336311 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification Survey, based on record review and interview, the facility failed to follow the care plan related to fall prevention interventions for Resident #6, 1 of 11 residents reviewed for implementation of the care plan. The findings included: The facility admitted Resident #6 with [DIAGNOSES REDACTED]. On 6/17/14 at 3:14 PM, review of the resident's care plan dated 2/17/14 - 6/17/14 revealed Falls was identified as a problem area. The care plan indicated the resident had a fall on 1/23/14 and on 3/11/14. Further review of the care plan indicated a new intervention was added dated 3/11/14 for Anti tippers on wheelchair. There was no intervention added following the 1/23/14 fall listed on the comprehensive care plan. Review of the Patient /Resident Incident /Accident Investigation Worksheet dated 1/23/14 revealed Follow up/steps taken to prevent reoccurrence . was listed to Check resident Q (every) hour during 11-7 shift added to profile. Review of the Patient /Resident Incident /Accident Investigation Worksheet dated 3/12/14 revealed the Follow up/steps taken to prevent reoccurrence . stated Talk with Therapy about placing resident in Geri-chair. Review of the Resident Profile revealed the hourly checks during the night shift was listed. Review of the Point of Care CNA (Certified Nursing Assistant) documentation 1/23/14 through 6/18/14 revealed there was no documentation that the resident was checked hourly during the night shift. Review of the Occupational Therapy Notes revealed a note dated 3/17/14 that stated Measured patient for appropriate size w/c (wheel chair) to be at 16 inches wide. Further review review revealed a note dated 3/19/14 that stated Patient continues to be in 18 inch w/c at 17/5 inch height with anti thrust cushion and rear anti tippers. Resident #6 was observed on 6/16/14 at 2:50 PM, and 4:07 PM and on 6/17/14 at 8:54 AM and 12:35 PM, with no anti-tippers observed on the wheel chair. During an interview on 6/17/14 at 6:20 PM, Certified Nursing Assistant (CNA) #1 confirmed there were no anti-tippers on the resident's wheel chair. During an interview on 6/18/14 at 3:20 PM, the Director of Nursing (DON) confirmed the care plan was not followed related to the anti-tippers. The DON stated that therapy had declined the recommendation for a Geri-chair but had added anti-tippers to the resident's wheel chair. The DON further stated that s/he thought that when therapy measured the resident for a more appropriate sized wheel chair that the anti- tippers were left off when the wheel chair was changed. The DON also confirmed the hourly checks during the night was on the Resident Profile but not on the comprehensive care plan. The DON further confirmed there was no place in the computer to document the hourly checks and that there was no documentation that the hourly checks during the night shift had been done. 2018-04-01
6262 MAGNOLIA MANOR - GREENVILLE 425090 411 ANSEL ST GREENVILLE SC 29601 2014-06-19 317 D 0 1 336311 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of survey based on record review, interview, review of the facility provided policy for Restorative Nursing Policies and Procedures (revised 2/2012) the facility failed to ensure that a resident who enters the facility does not experience a reduction in range of motion (ROM) for one of two residents reviewed with decline in ROM. Resident # 10 experienced a decline in range of motion without evidence the facility assessed and or provided preventative services to prevent the decline. The findings included: Resident #10 was admitted to the facility with [DIAGNOSES REDACTED]. On 06/18/14 at approximately 9 AM, review of Resident #10's MDS (Minimum Data Set), revealed documentation of a decline in ROM (Range of Motion) since admission. A Joint Mobility Screen was completed on 02/01/13 and documented the resident as having full ROM. The initial resident's MDS, dated [DATE] showed no upper or lower extremity impairment. An annual assessment MDS, dated [DATE], also documented no upper or lower extremity impairment. A restorative plan of care was initiated 8/2013 documented the Resident was to receive upper body strengthening and mobility participation. The restorative plan of care was discontinued on 1/24/14. A quarterly MDS dated [DATE], Section G, documented a decline in range of motion for the Resident's kip, knee, ankle and foot. The assessment instructions stated: Code for limitation that interfered with daily functions or placed the resident at risk of injury. The same MDS also documented no Range of Motion services were being provided. (Section O). Review of the facility provided policy for Restorative Nursing Policies and Procedures (revised 2/2012) stated: Patients/residents will be assessed for joint mobility limitation upon admission, re-admission, quarterly, annually, and with significant changes through the comprehensive nursing assessment. A restorative program will be implemented through the care plan to increase, maintain or prevent deterioration of joint mobility and maximize physical function when referral to therapy is not indicated or on discharge from skilled therapy. Orthotic, assistive or prosthetic devices will be provided if indicated. Appropriate candidates for Nursing Restorative ROM program may include, but are not limited to, patients/residents with the following condition .Contractures .decreased range of motion. During an interview with the Regional Nurse Consultant at the time of the findings, verified that no quarterly assessment had been completed for Resident # 10 since 2/1/ . 2018-04-01
6263 MAGNOLIA MANOR - GREENVILLE 425090 411 ANSEL ST GREENVILLE SC 29601 2014-06-19 318 D 0 1 336311 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification Survey, based on observation, record review, and interview, the facility failed to ensure that splints were applied as ordered to prevent decrease in Range of Motion (ROM) for Residents #4 and #6, 2 of 4 residents reviewed with orders for splints. The Findings included: The facility admitted Resident #4 with [DIAGNOSES REDACTED]. Resident #4 was observed during the initial tour on 6/16/14 and at 2:45 PM and 4:30 PM and on 6/17/14 at 8:57 AM and 12:15 PM. No splints were observed on the resident's right hand. On 6/16/14 at 4:19 PM, review of the Physician order [REDACTED]. Review of the May and June, 2014 Nursing Rehab/Restorative Plan of Care revealed the Plan of Care was implemented on 3/17/14 and listed as Approach #1 was ROM technique to R(ight) hand/wrist/elbow. Approach #2 was listed as Application of splint up to 8 hrs. Review of the Plan of Care revealed no documentation for Approach #2 for the month of June, 2014. During an interview on 6/19/14 at 9:50 AM, Certified Nursing Assistant (CNA) #3 confirmed the right hand splint was not on Resident #4. The CNA stated that s/he was about to give the resident a bath and would apply the splint afterwards. The CNA stated that s/he was sure it was on yesterday but did not state whether it was on on Monday and Tuesday. The facility admitted Resident #6 with [DIAGNOSES REDACTED]. On 6/16/14 at 3:05 PM, review of the Physician order [REDACTED]. Resident #6 was observed in bed on 6/16/14 at 4:07 PM with no splints observed. On 6/17/14 at 5:15 PM, Registered Nurse (RN) #1 provided copies of the May and June, 2014 Nursing Rehab/Restorative Plan of Care. Review of the documentation revealed the Plan of Care was implemented 5/6/14 and listed Approach #1 was bilateral ROM. Approach #2 was listed as Don/Doff splints. Additional review revealed documentation of performance of approach #1 but no documentation for Approach #2. RN #1 confirmed there was no documentation of donning and doffing of the bilateral knee splints at that time. On 6/18/14 at 3:20 PM, the Director of Nursing (DON) confirmed s/he was unable to determine how often Resident #6's splints were being applied. The DON also confirmed the order for the splints was unclear for Resident #6 and so is the documentation of the Restorative Nursing for Residents #4 and #6. 2018-04-01
6264 MAGNOLIA MANOR - GREENVILLE 425090 411 ANSEL ST GREENVILLE SC 29601 2014-06-19 322 D 0 1 336311 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of survey, based on observation, interview, and review of the manufacturer's guidelines (Abbott Nutrition - [MEDICATION NAME] 1.5) the facility failed to provide appropriate treatment and services for one of one sampled residents reviewed with a gastric tube. Resident # 8's gastric feeding was not administered as ordered by the physician. The findings included: On 06/17/14 at approximately 6:15 PM, Resident #8 was observed sitting in a geri-chair and a tube feeding scheduled to start at 4:00 PM was not running. A partially empty [MEDICATION NAME] 1.2 formula with tubing dated 06/16/14 at 4 AM was in place on the pole. During an interview with Licensed Practical Nurse (LPN) #4 at approximately 6:25 PM, the nurse was questioned as to why the tube feeding had not been begun as ordered and why s/he had documented on the Medication Administration Record that it was infusing as ordered. LPN #4 replied that s/he was waiting for the resident to be put back to bed and that s/he had initialed it but left blank on the MAR where it stated stated on. When informed that the physician's orders [REDACTED].#4 and the Assistant Director of Nurses placed the resident back to bed and began the feeding. 2018-04-01
6265 MAGNOLIA MANOR - GREENVILLE 425090 411 ANSEL ST GREENVILLE SC 29601 2014-06-19 333 E 0 1 336311 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification survey, based on record review and interview, the facility failed to ensure that 3 of 11 residents reviewed for medication assessment were free of significant medication errors. The facility failed to administer insulin per Fingerstick Blood Sugar (FSBS) results as ordered for Resident #3 and Resident #4. Resident #11 did not receive [MEDICATION NAME] as ordered for low hemoglobin results. The findings included: The facility admitted Resident #3 to the facility with [DIAGNOSES REDACTED]. On 6/18/14 at approximately 4:00 PM, record review revealed a 1-4-11 physician's orders [REDACTED].Check BS (blood sugar) before meals and HS (bedtime). Give additional 15 units of [MEDICATION NAME] if BS > (greater than) 400 then Recheck in 1 hour and call MD (physician) if > 400. Review of the 4/14 Medication Flowsheet on 6/18/14 revealed that a FSBS was not checked on 4/23/14 at 11:30 AM and 4/13/14 at 9:00 PM. The FSBS was not rechecked in 1 hour as ordered for results > 400 on 4/6/14 at 11:30 AM when the BS was 508 and on 4/14/14 at 11:30 AM when the BS was 495. Review of the 5/14 Medication Flowsheet revealed that on 5/2/14 at 9:00 PM, a blood sugar of 422 was recorded with no noted insulin given or recheck of the BS as ordered. On 5/12/14 at 4:30 PM, a blood sugar of 507 was recorded with no noted insulin given or BS recheck. Also, there were no FSBS results documented for 5/31/14 at 4:30 PM. Review of the 6/14 Medication Flowsheet revealed that the blood sugar for 6/13/14 at 4:30 PM was not done as ordered. During an interview with the Assistant Director of Nursing on 6/18/14 at approximately 4:00 PM, s/he verified that the blood sugars were not documented as done per the physician's orders [REDACTED]. The facility admitted Resident #11 with [DIAGNOSES REDACTED]. On 6/19/2014 at approximately 8:30 am, record review revealed 1-29-13 physician's orders [REDACTED].Injection .Give if Hgb (Hemoglobin) Review of the Medication Administration Records (MARs) revealed that [MEDICATION NAME] was not given as ordered from 10/2013 through 6/2014 based on the hemoglobin and hematocrit levels. Record review revealed that the dates scheduled for [MEDICATION NAME] administration on the MAR indicated [REDACTED]. On 10-23-13, the Hgb was 10.3 g/dL (normal range 13.0-16.5). [MEDICATION NAME] was scheduled for administration on the MAR for 10-25-13, but was not initialed as given. On 11-22-13, the Hgb was 10.1. [MEDICATION NAME] was scheduled for administration on the MAR for 11-22-13, but the nurse's initials were circled, indicating the medication was omitted. On 4-7-14, the Hgb was 9.4. The MAR indicated [REDACTED]. On 4-23-14, the Hgb was 8.8. [MEDICATION NAME] was scheduled for administration on the MAR for 4-25-14, but was not initialed as given. The MAR indicated [REDACTED]. The [MEDICATION NAME] was not initialed as given on 5-9-14. On 5-23-14, [MEDICATION NAME] was given, but the lab test was not drawn until 5-28-14 (Hgb = 8.9). On 6-6-14, the nurse's initials were circled on the MAR indicated [REDACTED]. During an interview on 6/19/14 at approximately 9:55 AM, the Assistant Director of Nursing confirmed that there was no evidence the [MEDICATION NAME] was administered as ordered/or was incorrectly administered. The facility admitted Resident #4 with [DIAGNOSES REDACTED]. On 6/16/14 at 4:19 PM, review of the Physician order [REDACTED]. Further review revealed an order for [REDACTED]. On 6/17/14 at 10:14 review of the Medications Flowsheet dated 6/1/14 - 6/30/14 revealed FSBS's greater than 300 on 6/3 at 4:30 PM, 6/4 at 6:30 AM and at 4:30 PM, 6/5 at 4:30 PM, 6/7 at 6:30 AM, 6/8 at 4:30 PM, 6/9 at 6:30 AM and at 4:30 PM and 6/10/14 at 6:30 AM with no administration of [MEDICATION NAME] documented. Review of the Medications Flowsheet dated 5/1/14 - 5/31/14 revealed a FSBS of 384 on 5/2/14 with no documentation of insulin administration. Further review of the 4/1/14 - 4/30/14 Medications Flowsheet revealed FSBS greater than 300 on 4/8 at 4:30 PM, 4/14 at 4:30 PM, 4/23 at 4:30 PM, 4/24 at 4:30 PM, 4/26 at 4:30 PM, 4/28 at 4:30 PM and 4/30 at 4:30 PM with no documentation that the [MEDICATION NAME] was administered as ordered. Review of the laboratory reports revealed the resident had a HgbA1C (Glycated hemoglobin) (used as a standard tool to determine blood sugar control for patients with diabetes) on 2/3/14 with a result of 9.5 with a notation that the result was slightly worse. During an interview on 6/18/14 at 10:25 AM, Registered Nurse #2 confirmed the [MEDICATION NAME]was not administered as ordered for FSBS greater than 300 and confirmed the result of the elevated HgbA1c. 2018-04-01
6266 MAGNOLIA MANOR - GREENVILLE 425090 411 ANSEL ST GREENVILLE SC 29601 2014-06-19 367 D 0 1 336311 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification Survey, based on observation, interview, and record review, the facility failed to provide the diet ordered by a physician for Resident #4 , 1 of 8 residents reviewed with orders for a therapeutic diet. The findings included: The facility admitted Resident #4 with [DIAGNOSES REDACTED]. On 6/16 at 4:19 PM, review of the Physician order [REDACTED]. On 6/17/14 at 12:15 PM, observation of the resident's lunch meal revealed the resident received 1 polish sausage, sauerkraut, mashed potatoes and a fruit cup. At 1:55 PM, review of the 2014 Diet Guide sheet revealed regular portions of the meal consisted of 1 polish sausage, ? cup sauerkraut and ? cup of mashed potatoes. The resident's portion of sauerkraut appeared to be the same as the mashed potatoes and both appeared to be about ? cup. Observation on 6/18/14 at 12:18 PM of the resident's lunch tray revealed a turkey club sandwich, potato chips and pudding. During an interview on 6/18/14 at 12:25 PM, the Dietary Manager (DM) confirmed Resident #4 had 2 slices of turkey on his sandwich and that it was not a double portion. The DM also confirmed that 1 sausage on 6/17/14 was not a double portion. The DM also confirmed the resident was supposed to receive double portions of meat or protein and vegetable three times a day and that no vegetable had been served on 6/18/14 except the lettuce and tomato on the turkey club sandwich. 2018-04-01
6267 MAGNOLIA MANOR - GREENVILLE 425090 411 ANSEL ST GREENVILLE SC 29601 2014-06-19 425 D 0 1 336311 On the days of the survey based on observations, record reviews, interviews, manufacturer product labeling and Drug Facts and Comparisons (updated monthly), the facility failed to follow a procedure to ensure that expired medication were not stored in 1 of 2 medication rooms. The findings included: On 6/16/14 at approximately 12:00 PM inspection of the West Wing medication room refrigerator revealed the following: -One opened vial of Tuberculin Purified Protein Derivative Aplisol 5 TU (test units)/0.1 ml (milliliter), 1 ml (10 tests) Lot 5. This vial was approximately 1/4 full and had been dated on the vial by the facility as opened 5/6/14. The manufacturer's (JHP Pharmaceuticals) label stated once entered, vial should be discarded after 30 days. The manufacturer's package insert and the Drug Facts and Comparisons book (updated monthly) page 2001 states (in reference to Tuberculin Purified Protein Derivatives): 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 6/16/14 at approximately 12:05 PM. During an interview on 6/17/14 at approximately 10:30 AM, LPN #2 stated that both the 3rd shift nurse and the nurse administering medications are responsible for checking the medication room for expired medications. 2018-04-01
6268 MAGNOLIA MANOR - GREENVILLE 425090 411 ANSEL ST GREENVILLE SC 29601 2014-06-19 496 D 0 1 336311 On the days of the survey, based on review of personnel files and interview, the facility failed to obtain registry verification for 1 of 2 newly hired Certified Nursing Assistants (CNA's) reviewed for registry verification. CNA #2 did not have the abuse registry checked prior to hire. The findings included: On 6/18/2014, review of personnel records for two newly hired CNA's revealed that CNA #2 did not have a registry verification in the file. During an interview on 6/18/2014 at approximately 4:30 PM, the Regional Clinical Services Director confirmed that a registry verification was not done for CNA #2 prior to hire, and that only a copy of the CNA's Registry wallet card was obtained. 2018-04-01
6269 MAGNOLIA MANOR - GREENVILLE 425090 411 ANSEL ST GREENVILLE SC 29601 2014-06-19 502 D 0 1 336311 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification Survey, based on interview and record review, the facility failed to ensure that laboratory (lab) studies were obtained as ordered by the physician for Residents #6 and #11, 2 of 11 residents reviewed for labs. The findings included: The facility admitted Resident #6 with [DIAGNOSES REDACTED]. On 6/16/14 at 3:05 PM, review of Physician order [REDACTED]. During an interview on 6/18/14 at 4:15 PM, the Director of Nursing (DON) confirmed the March labs were missing and that the November labs could not be located in the current or thinned record. The DON stated that the facility recognized a problem related to missing labs in November and December and that a PIP (Performance Improvement Plan) had been initiated in January related to missing labs. The DON also confirmed the March labs were also missed and that the facility was not aware the labs were not done. On 6/19/14 at approximately 8:30 AM, record review revealed an open ended 10/05/12 physician's orders [REDACTED]. Review of laboratory reports revealed that the quarterly lab tests were drawn on 11-1-13, but the results of the CMP could not be located. On 3-26-14, 4 months later, all labs were drawn and reported. On 5/5/14, all lab tests were reported except for the results of the CBC. During an interview on 6/19/14 at approximately 8:45 AM, the Assistant Director of Nursing verified that the labs were not done timely and labs were not done as ordered. 2018-04-01
6270 MAGNOLIA MANOR - GREENVILLE 425090 411 ANSEL ST GREENVILLE SC 29601 2014-06-19 507 D 0 1 336311 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification survey, based on record review and interview, the facility failed to have laboratory (lab) test results available in the record for clinical management for 1 of 11 residents reviewed for labs. Resident #11 did not have Hemoglobin results in the medical record and readily accessible for medication administration. The findings included: The facility admitted Resident #11 with [DIAGNOSES REDACTED]. On 6/19/2014 at approximately 8:30 am, record review revealed 1-29-13 physician's orders [REDACTED].Injection .Give if Hgb (Hemoglobin) Further review revealed that the laboratory results were not in the medical record and easily accessible for the staff to review for appropriate medication administration. During an interview on 6/19/14 at approximately 8:45 AM, the Assistant Director of Nursing stated that s/he had to obtain the laboratory results from the computer as they were not maintained in the chart. 2018-04-01
6271 MAGNOLIA MANOR - GREENVILLE 425090 411 ANSEL ST GREENVILLE SC 29601 2014-06-19 520 D 0 1 336311 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification Survey, based on interview and record review, the facility failed to implement a quality assessment and assurance (QAA) plan of action for missing laboratory (lab) studies that included monitoring of the plan of action and implementing changes as needed to ensure that labs were obtained as ordered for Residents #6, 1 of 11 residents reviewed for labs. The findings included: The facility admitted Resident #6 with [DIAGNOSES REDACTED]. On 6/16/14 at 3:05 PM, review of 6/1/14 - 6/30/14 Physician order [REDACTED]. At 4:42 PM on 6/17/14, record review revealed no March or November results for the serum ferritin, iron level, iron sat, B12 level, or folate in the record. During an interview on 6/18/14 at 4:15 PM, the Director of Nursing (DON) confirmed the missing labs. The DON stated that the facility recognized a problem related to missing labs in November and December and that a PIP (Performance Improvement Plan) had been initiated in January related to missing labs. The DON stated that an audit had been done to identify any residents whose labs had not been done. The DON further confirmed the labs for Resident #6 were missed when the audit was completed and that the facility was not aware the labs were not done. On 6/19/14 at 9:30 AM, an interview was conducted with the Assistant Director of Nursing (ADON). The ADON confirmed a 100% audit had been conducted in March relative to the QAA Performance Improvement Plan and stated that the lab orders were now recorded in the lab book. The ADON further stated that, during the audit, any orders for labs that had not been done were re-written and recorded in the lab book. The ADON confirmed the lab orders for Resident #6 were missed and the labs were not obtained in March. When asked why the audit had not been done until March for a QAA that had been implemented in January, the ADON stated I don't know. I didn't realize we did it (the PIP) in January. On 6/19/14 at approximately 2:00 PM, the facility's Clinical Consultant declined to provide the QAA or PIP for review to the surveyor, stating that it was not a strong QAA. 2018-04-01
6282 HONORAGE NURSING CENTER 425115 1207 NORTH CASHUA ROAD FLORENCE SC 29501 2014-06-19 248 D 0 1 CZWK11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey based on observations, record review and interviews, the facility failed to provide a resident with an ongoing program of activities for 1 of 2 sampled residents reviewed for activities and random observations of multiple residents not being provided with activities. Resident #7 was observed several times in the room while activities of his/her preference were being offered. The findings include: The facility admitted Resident #7 with the [DIAGNOSES REDACTED]. Review of the Annual Minimum Data Set with the Assessment Reference Date of 8/27/13, documented the resident had short and long term memory impairment and moderately impaired cognitive skills for daily decision making. The MDS also indicated it was important for the resident to do his/her favorite activities, important for him/her to listen to music, very important to do things with group of people and very important to participate in religious activities. During an interview with Resident #7's responsible party on 6/17/14 at approximately 9:53 AM, s/he stated that the resident does not participate in activities due to being bedfast and was not aware if the resident attended activities. Review of Resident #7's Activity Evaluation on 6/17/14 at approximately 2:28 PM revealed the residents current interest included music and spiritual/religious activities. Review of the Activities progress note form dated 2/13/14 on 6/17/14 at 2:44 PM revealed a Quarterly Activity assessment that specified the resident current interests were religious services, group socializing and frequent visitors. Resident #7's activities care plan with a problem onset of 2/20/14 noted: Dependent on staff for all activities, cognitive stimulation and social interaction due to [MEDICAL CONDITION] and Dementia. S/he has frequent visits from his/her family and church family. Interventions related to activities noted Assist to and from activities as needed and invite to scheduled activities. Resident #7's room was observed initially on 6/17/14 at approximately 11:00 AM. The resident did not have a radio or any other means to listen to music in the room. During this observation the resident was reclined in Geri chair with eyes closed. Additional observations of Resident #7 included the following: 6/17/14 at approximately 3:10 PM the resident was observed in the room lying in bed. The resident was not observed in activities today. A hamburger social was ongoing in the activity area on the west hall. 6/18/14 at approximately 10:32 AM a musical/religious activity was being conducted in the activity room. The resident was observed in his/her room, sitting in Geri chair. 6/18/14 at approximately 2:20 PM revealed the resident in the bed while a group activity of Bingo was ongoing in the activity room. On 6/18/14 at approximately 2:29 PM, Certified Nursing Assistant (CNA) #1 who was assigned to care for Resident #7 was interviewed. During the interview with CNA #1 s/he verified that the resident had not been to group activities provided by the facility. CNA #1 stated the resident stayed in the room most of the day and stated that the resident does like to attend spiritual/religious activities. On 6/18/14 at approximately 2:47 PM the Activity Director was interviewed and stated that Resident #7 participates in very few activities. Majority of his/her activities are one to one visits. We try to do one to one activities for residents who cannot participate in group activities.The Activity Director on 6/18/14 at approximately 3:00 PM, stated every day one of the Activity department employees went to each resident to say good morning which s/he documented as an activity. Further review of the activity log indicated movies/television was considered as an in room activity. On 6/18/14 at approximately 4:12 PM an interview was done with Activity Assistant #1. During the interview s/he stated that the daily greeting and conversation only last a couple of minutes and s/he was just informed that Resident # 7 needed to be added to one to one for activities. 2018-04-01
6283 HONORAGE NURSING CENTER 425115 1207 NORTH CASHUA ROAD FLORENCE SC 29501 2014-06-19 249 E 0 1 CZWK11 On the days of the survey based on record review and interview, it was determined the facility failed to have a qualified activities professional to direct the provision of activities for facility residents as required. A review of the qualifications of the facility's Activity Director (AD) revealed the AD had not received an approved training course or had the required full time experience for the provision of activities. The findings include: A review of the qualifications of the facility's Activity Director revealed it did not meet the regulatory requirement as an Activity Director. S/he was not a qualified Therapeutic Recreation Specialist or an Activities Professional who was licensed or registered; or had two years experience in a social or recreational program within the previous five years, one of which was full-time in a patient activity program in a health care setting; or was a qualified Occupational Therapist or assistant and/or has completed a training course approved by the state. During a review of the personnel file for the current Activities Director on 6/19/14 at approximately 9:00 AM revealed the AD was previously employed as a Housekeeping Supervisor in 2008 and in December 2010 became an activity employee. The Activity Director from 2010 to present had been working as the Housekeeping Supervisor and in activities. There was no evidence in the personnel folder to indicate the AD met the appropriate qualifications. An interview with the Administrator on 6/19/14 at approximately 9:20 AM revealed the AD had been working as the Housekeeping supervisor and Activity Director. The Administrator verified s/he did not meet the appropriate qualifications. 2018-04-01
6284 HONORAGE NURSING CENTER 425115 1207 NORTH CASHUA ROAD FLORENCE SC 29501 2014-06-19 309 D 0 1 CZWK11 **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 necessary care and services to attain or maintain the highest practicable physical well-being for 1 of 19 residents reviewed for care and services. The facility failed to notify the physician and start treatment in a timely manner for Resident #58 with no documented bowel movement for 6 days. The findings included: The facility admitted Resident #58 with [DIAGNOSES REDACTED]. The resident is currently receiving Hospice services. Review of the medical record revealed the care plan noted the potential for alteration in bowel pattern related to [DIAGNOSES REDACTED]. Documented interventions included monitor for adverse drug events affecting bowel pattern (constipation .) and notify MD if observed and observe for s/s (signs and symptoms) of constipation. Review of the Nurses's Notes dated 6/2/14 indicated, hospice Nurse in facility, made hospice Nurse aware that resident has not had a bowel movement since 26th, Hospice nurse made dr. aware and wishes to order [MEDICATION NAME] for resident, awaiting order and directions from dr. Review of the Hospice Nurses's Notes dated 6/2/14 revealed, .last BM 5/26/24. No bowel regimen. Will notify MD to restart bowel regimen. Review of the BM Report Roster confirmed the finding that Resident #58 had not had a bowel movement from 5/27/24 until 6/2/14. Review of the Physician's Telephone Orders dated 6/5/14 indicated Senna-S twice daily was ordered on that date. Review of the June 2014 Medication Administration Record [REDACTED]. During an interview on 6/18/14, the Director of Nursing (DON) reviewed the above documentation and confirmed the findings. The DON was asked if the facility had a Bowel Protocol policy and stated that there was no written protocol. During the interview, the DON stated that the Certified Nursing Assistants document daily in the BM Report Roster, and the report is reviewed daily during the staff meeting. Review of the facility's Standing Orders indicated that Laxative or enema of choice prn (as needed) was included in the orders. 2018-04-01
6579 FLORENCE REHAB & NURSING CENTER 425163 133 WEST CLARKE ROAD FLORENCE SC 29501 2014-06-19 155 D 0 1 T4HW11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, record review, and interview, the facility failed to afford one of 22 sampled residents reviewed the right to formulate his/her own advance directive. Resident #122 was not informed of nor afforded the right to formulate his/her own advance directive. The findings included: During multiple observations throughout the survey (on 6-16-14 at 3:24 PM and 4 PM; on 6-17-14 at 8:55 AM and 3 PM; on 6-18-14 at 9 AM, 11:45 AM; and on 6-19-14 at 8:40 AM), and during the Resident Interview during Stage 1 of the survey (6-17-14 at 9:48 AM), Resident #122 was able to respond reasonably to all questions posed. Record review on 6-17-14 at 3:45 PM revealed no [DIAGNOSES REDACTED]. Admission Nursing Assessments dated 6-3, 6-9, and 6-14-14 revealed no documented confusion or memory problems. Further review of the medical record revealed that the resident's family member signed the Advance Directives-Acknowledgement of Receipt form on 6-3-14, indicating the resident has chosen to formulate and issue an Advance Directive of Do Not Resuscitate (DNR). A physician's orders [REDACTED]. During an interview on 6-18-14 at 2:30 PM, Social Services verified that the resident's family had signed the advance directive instead of the resident. S/he stated that, since admission, Resident #122 had been able to answer questions appropriately and was a '12' on the BIMS (Brief Interview for Mental Status), indicating minimal cognitive impairment. Social Services stated s/he was confused about the middle category of BIMS being interviewable. 2017-12-01
6580 FLORENCE REHAB & NURSING CENTER 425163 133 WEST CLARKE ROAD FLORENCE SC 29501 2014-06-19 157 E 0 1 T4HW11 **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 Physician Notification (11-10-09), the facility failed to notify the physician and interested family member of changes in the residents' medical conditions potentially requiring physician intervention for one of twenty-two sampled residents reviewed for notification. Nursing staff failed to notify the attending physician and family of both low and high blood pressure (BP) readings for Resident #122 who was on [MEDICAL TREATMENT] and routine antihypertensive medication. The findings included: The facility admitted Resident #122 with [DIAGNOSES REDACTED]. Review of Daily Skilled Nurse's Notes on 6-17-14 at 4:40 PM revealed that the 7 AM-3 PM shift that day had documented an untimed BP of 68/34. There was no narrative entry for that shift to indicate that the physician had been notified. When questioned, the 3-11 PM Licensed Practical Nurse (LPN) #6 and LPN #3 were unaware of the low BP. After contacting Licensed Practical Nurse (LPN) #5, who had worked the day shift, LPN #3 confirmed that the physician had not been notified. When asked about what the BP reading was that afternoon, the nurses obtained a result of 80/60 from a Certified Nursing Assistant. Further review of Daily Skilled Nurse's Notes revealed a BP of 80/60 recorded on the evening shift on 6-12-14. There was no evidence of physician notification in the record. The next BP recorded was taken at approximately 5:30 PM prior to the resident being sent to the emergency room when noted to be anxious, SOB (short of breath), + having labored breathing .80/62 . On 6-10-14, an untimed BP of 189/71 was recorded on the evening shift. There was no narrative entry for that shift, indicating that the physician had been notified. During an interview at approximately 4:45 on 6-17-14, LPN #3 reviewed the medical record and confirmed that the physician had not been notified of the above. Review of the facility policy entitled Physician Notification (11-10-09) revealed that nursing staff should Call MD if systolic blood pressure is less than 90 (or) .greater than 180 . Please remember that the responsible party needs to be notified as well. Please be sure to document this in the medical record. 2017-12-01
6581 FLORENCE REHAB & NURSING CENTER 425163 133 WEST CLARKE ROAD FLORENCE SC 29501 2014-06-19 241 E 0 1 T4HW11 On the days of the survey, based on observation, review of the facility provided policy related to dignity, and interview, the facility failed to provide an environment to promote dignity of residents during the dining experience and while transporting residents. Staff placed gowns and clothing protectors over Residents #82, #6, and one randomly observed resident in one of two dining rooms. Staff were also noted to move randomly observed residents in gerichairs/ wheelchairs without addressing the residents. The findings included: During meal observations on 6-16-14 at 12:53 PM, on 6-17-14 and 6-18-14 at breakfast and lunch meals, and on 6-19-14 at 8:28 AM, Resident #82 was noted at a table facing the door in the dining room on East Hall with a gown and clothing protector over his/her clothing. Two other residents (#6 and a randomly observed resident) seated at another table were also noted dressed/draped in the same manner. Resident # 6 was being fed by a staff member seated at his/her side and the randomly observed resident was feeding him(her)self. During an interview on 6-18-14 during the breakfast meal, Licensed Practical Nurse #3 noted that the resident had increased spillage and stated, That's why we put the gown on him (her). During an interview on 6-19-14 at approximately 11:30 AM, the Director of Nursing and Registered Nurse (RN) Consultant stated they had never observed residents draped with gowns in the dining room and were unaware staff were in the habit of doing so. At 1:15 PM on 6-19-14, the residents were again observed in the West Hall dining room in the same condition. This was brought to the attention of the RN consultant who confirmed the observation. Random observations on 6/18/14 at 12:25 PM and 3:34 PM revealed CNA (Certified Nursing Assistant) #1 approached two different residents and without addressing the residents, began moving the resident(s) to another location. He/she also was observed to pull a resident backwards and out of the way of another resident with informing the resident of his/her intention. On 6/18/14 at 4:04 PM, during an interview with CNA #1, he/she confirmed that he/she did not always address residents prior to moving them to another location. The facility provided a policy related to dignity which states: Always introduce yourself and always explain what you are going to do before you do it. Don't just go up to a resident and start pushing them to the D/R(dining room) to eat without saying a word, instead you should say 'Mrs.(NAME)This(sic)(NAME)if your are ready to go to lunch I will take you to the D/R now.' 2017-12-01
6582 FLORENCE REHAB & NURSING CENTER 425163 133 WEST CLARKE ROAD FLORENCE SC 29501 2014-06-19 253 E 0 1 T4HW11 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 3 of 3 Halls. There were housekeeping/maintenance concerns identified during the survey related to furniture, vents, doors, and walls. The findings included: During the Initial Tour of the facility on 06-16-14 at approximately 10:00 AM and on all days of the survey, random observations revealed the following: East Unit: 1. Room #10: Vent and toilet tissue holder with rust-color noted in the bathroom. Lower area of 4 drawer dresser with black/brown stains noted. 2. Room #16 A: Vent with rust color noted under the bathroom window, brown rust color noted around bathroom sink faucet. 3. Room #17 B: Headboard rough to touch. Center Hall: 1. Room #21: Paint on inside of the bathroom door scraped, scraped paint to the left side of the bed beside the wall. 2. Room #24 B: Vent with rust color noted under the bathroom window, 2 small holes noted in the wall to the right side of the picture in the bathroom, scraped paint to the left side of the wall beside the bed. West Hall: 1. In the area of Shower room near Room #35: Floor tile noted with approximately 5 inch gouge. 2. Shower near Room #43: Tile loose at right side of toilet. 3. Room #26 A: Broken toilet paper holder. 4. Room #31 A: Scuffed room door. During a Walking Tour on 06-19-14 at approximately 3:00 PM, in the presence of the Maintenance Supervisor, the Housekeeping Manager, and the Housekeeping Supervisor, the above findings were verified. During an interview on 06-19-14 with the Administrator, h/she stated many environmental issues presently identified were previously identified by the facility and corrections have begun. However, review of the information provided by the facility did not address the above environmental findings. 2017-12-01
6583 FLORENCE REHAB & NURSING CENTER 425163 133 WEST CLARKE ROAD FLORENCE SC 29501 2014-06-19 272 D 0 1 T4HW11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the survey based on observation, record review and interview the facility failed to accurately assess functional capability for 1 of 3 residents reviewed for assessments related to range of motion. There was no evidence of a contracture assessment related to potential contractures for Resident #25's hands. The findings included: Resident #25 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Observations of Resident #25 throughout the days of the survey revealed apparent contractures of both hands. Observation on 6/16/2014 at 3:45 PM revealed Resident #25 in bed asleep with both hands in a closed fist position on top of his/her stomach area. Observation on 6/17/14 at 8:50 am and on 6/18/14 at 9:00 am revealed both hands to be clenched in a fist. Observation of Resident #25 on 6/19/14, following the lunch meal, revealed the resident could feed self with his/her left hand using a spoon. Review of the current Care Plan dated 4/7/14 revealed Resident #25 required assistance with activities of daily living. Goal approaches included: PROM (passive range of motion) with ADL (activities of daily living) care daily. Review of Physical Therapy assessment dated [DATE] documented impaired for upper left and right extremities. During an interview with the OTR (Occupational Therapist) on 6/19/14 at approximately 1:55 PM revealed Resident #25 had been discharged from Physical Therapy on 5/6/14. Further interview revealed Resident #25 had not been assessed by Occupational Therapy because the resident had good upper body strength. The OTR verified both hands were contracted and the right hand was more so than the left. S/he also stated that Resident #25's hand contractures had gotten worse because the resident could open both hands upon admission to the facility. When asked if Resident #25's hand contractures had been assessed for the need of additional intervention, the OTR stated No, they have not. ? 2017-12-01
6584 FLORENCE REHAB & NURSING CENTER 425163 133 WEST CLARKE ROAD FLORENCE SC 29501 2014-06-19 309 E 0 1 T4HW11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, record review, and interview, the facility failed to provide necessary care and treatment for one of one resident reviewed receiving [MEDICAL TREATMENT] services. The facility failed to monitor the [MEDICAL TREATMENT], failed to monitor fluid intake, and failed to communicate amended diet and fluid intake orders to the [MEDICAL TREATMENT] clinic for Resident #122. Also, there was no evidence of communication of laboratory results from the [MEDICAL TREATMENT] clinic to the facility for Resident #122. Additionally, the facility failed to accurately monitor/document the intake and output as ordered by the physician for two of five sampled residents reviewed for hydration/intake and output (Residents #122 and #82). Cross refer to F 315 as it relates to the care of a resident with a Foley catheter The findings included: The facility admitted Resident #122 with [DIAGNOSES REDACTED]. Record review on 6-17-14 at approximately 3:15 PM revealed that the resident was hospitalized from 6-7-14 to 6-9-14 for Volume Overload and 6-12-14 to 6-14-14 for [MEDICAL CONDITION]. Record review on 6-16-14 at 4 PM revealed that Resident #122 was admitted with a physician's orders [REDACTED]. Intake & Output. A dietary assessment was completed on 6-6-14. Nutritional Interventions Recommended and physician's orders [REDACTED]. Record review on 6-17-14 at 3:25 PM revealed a Fluid Restriction form in front of the chart to delineate the breakdown of fluid to be administered by nursing and dietary. Nursing was to give 60 cc of fluids with the medication pass four times daily. Dietary was to give 360 cc with each meal. Total = 1080 + 240=1320 cc which left 180 cc for the remainder of the day. No intake and output record was noted in the resident's room, closet, or bathroom for Certified Nursing Assistant (CNA) use to record total intake. During an interview on 6-17-14 at 3:30 PM, Licensed Practical Nurses (LPNs) #3 and #5 were asked how the staff was handling the fluid restriction for Resident #122. LPN #5 referred the surveyor to a fluid breakdown sheet in the Medication Administration Record (MAR). When asked how CNAs knew about the fluid restriction and what the resident could/could not have on their shift, LPN #5 referred to an instruction sheet (CNA Care Plan) on the inside of the resident's closet door. When reviewed with the surveyor, the nurse confirmed no instructions were noted on the form for a fluid restriction. LPN #3 stated, The resident should have a 'no water pitcher' sign over the bed. That sign was also not present as verified by LPNs #3 and #5. LPN #3 stated, I have 3 places to put the information for a fluid restriction: a sign over the bed, inside the closet, and in the ADL (Activities of Daily Living-CNA Care Plan) book. I don't know how I missed it. Review of the medical record and [MEDICAL TREATMENT] Communication forms (dated 6-4-14, 6-11-14, 6-16-14) on 6-17-14 at 3:45 PM revealed no evidence of notification to the clinic about the discontinuance of the renal restriction or of starting a Ready Care supplement. No results of laboratory tests done at the [MEDICAL TREATMENT] clinic were noted on the communication sheets and no reports from [MEDICAL TREATMENT] could be located. During an interview on 6-18-14 at 9:40 AM, LPN #3 stated, [MEDICAL TREATMENT] doesn't usually send labs. They may send a report at the end of the month. S/he verified there were no lab reports from [MEDICAL TREATMENT] in the record. When asked if the dietary supplement had been calculated into the daily fluid restriction or if this was in addition to the 1500 cc restriction, LPN #6 did not know, but stated s/he had not been adding the 120 cc given on evening shift into the recorded fluid intake. LPN #3 reviewed the form in the front of the chart and on the MAR and confirmed that the additional fluid had not been calculated into daily fluid restriction. Review of the Intake & Output Monitoring Log and interview with LPNs #3 and #5 revealed that it did not reflect an accurate fluid intake as it did not include meal intake, the amount of fluid given with medication, and the amount of the liquid supplement that had been ordered on 6-6-14. When asked if the [MEDICAL TREATMENT] clinic had been notified of the change in the diet order and the addition of the supplement, LPN #3 stated s/he had not told them, but that the dietitian had made the changes, so s/he might have contacted the clinic. During an interview at 4:45 PM on 6-17-14, the Registered Dietitian stated s/he did not communicate with the [MEDICAL TREATMENT] clinic about the addition of Ready Care or about discontinuing the renal restriction. The RD reviewed the fluid allotment form and stated that s/he had not made adjustments to the dietary or nursing fluid intake to accommodate the additional 240 cc per day. During an interview on 6-16-14 at 12:16 PM, LPN #5 stated that the resident had taken a snack of a peanut butter and jelly (PB&J) sandwich, oatmeal pie, 4 ounce can of ginger ale, and applesauce with him/her to [MEDICAL TREATMENT]. On 6-17-14 at 8:55 AM, Resident #122 was served and consumed 180 cc milk and 180 cc cranberry juice with his/her breakfast. The diet card noted the resident was to receive 240 cc of milk and 120 cc of juice each meal. ( A speech therapy student verified the amount of fluids on the tray.) A copy of the diet card was provided on 6-18-14 at 5 PM by the Certified Dietary Manager (CDM) who stated that the diet card for all meals was the same. On 6-18-14, during observation of the lunch meal, 2 sizes of glasses were used- one was 120 cc and the second appeared to be approximately 180 cc. When questioned about the fluid content, LPN #3 stated s/he thought the larger of the two held 180 cc. The CDM stated they held 240 cc. After measuring to the fill level, the CDM stated they held 180 cc and had to be filled to the top rim to hold 240 cc. On 6-18-14 at 11:45 AM, Resident #122 left the facility for [MEDICAL TREATMENT] with a snack of a 240 cc can of Glucerna, a 4 ounce can of ginger ale, applesauce, and a PB&J sandwich which was verified by the transporter and CNA #4. The CDM stated, He (she) does not need the soda. However, LPN #5 was observed to remove the Glucerna from the bag. On 6-19-14 at 8:40 AM, Resident #122 received 240 cc milk and 120 cc juice for breakfast. Observation on 6-16-14 at 4 PM revealed a dressed [MEDICAL TREATMENT] access (shunt) site on the bruised right forearm of Resident # 122. Record review on 6-17-14 at 4 PM revealed Admission physician's orders [REDACTED]. No documentation could be found of routine monitoring of the [MEDICAL TREATMENT] site for thrill and bruit. On 6-18-14 at 9:58 AM, LPN #3 reviewed the medical record and stated, It should be documented on the TAR. S/he verified it was not. The facility admitted #82 with [DIAGNOSES REDACTED]. Record review on 6-18-14 at 5:35 PM revealed physician's orders [REDACTED]. There was also an order [REDACTED]. Review of the resident's Intake and Output Monitoring logs on 6-19-14 at 8:30 AM revealed they were incomplete and/or did not reflect that physician's orders [REDACTED]. During May of 2014, 10 of 31 days were incomplete or did not reflect the intake of 270 cc per shift or 300 cc every 6 hours as required. During an interview on 6-19-14 at 10:53 AM, the Director of Nurses (DON) and Registered Nurse Consultant verified that the intake records did not reflect the physician's orders [REDACTED]. The facility admitted Resident #89 with [DIAGNOSES REDACTED]. Record review on 6/18/14 revealed a current physician's orders [REDACTED]. Review of the current care plan revealed an approach to monitor intake and output every shift with a start date of 3/14/14. Review of the Intake and Output Monitoring Log for March 2014, April 2014 and May 2014 revealed multiple times intake and output was not monitored/recorded as follows: March 2014 March 1, 2014-11p-7a intake; 7a-3p intake/output March 2, 2014-7a-3p intake/output March 9, 2014- 3p-11p intake/output March 10, 2014-11p-7a-intake/output March 11, 2014-11p-7a-output March 15, 2014-11p-7a-ouput; 3p-11p intake/output March 16,2014 11p-7a-intake/output March 21, 2014-3p-11p-ouput March 22, 2014-7a-3p-intake/output March 23, 2014-7a-3p-intake/output March 24, 2014 11p-7a-ouput March 25, 2014-3p-11p-intake/output March 27, 2014-3p-11p-intake/output March 31, 2014-7a-3p-intake/output and 3p-11p-intake/output April 6, 2014-7a-3p-intake/output April 10, 2014-11p-7a-output April 11, 2014-11p-7a-intake/output and 7a-3p-output April 12, 2014-11p-7a-intake/output April 26, 2014-3p-11p-intake/output April 27, 2014-11p-7a-intake/output and 3p-11p-intake-output April 28,2014-11p-7a-intake/output May 4,2014-11p-7a-intake/output May 10, 2014-3p-11p-intake/output May 11, 2014-intake/output not documented for all three shifts May 12, 2014-11p-7a-intake/output May 13,2014-11p-7a-intake/output May 16, 2014-11p-7a-intake/output May 21, 2014-11p-7a-output May 24, 2014 11p-7a-output May 25, 2014-7a-3p-intake/output On 6/19/14, the Nurse Consultant reviewed the Intake and Output Logs and confirmed the lack of evidence that the physician's orders [REDACTED]. 2017-12-01
6585 FLORENCE REHAB & NURSING CENTER 425163 133 WEST CLARKE ROAD FLORENCE SC 29501 2014-06-19 315 E 0 1 T4HW11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record reviews, interviews, and review of the facility policy titled Intake and Output, the facility failed to provide appropriate care and services for 2 of 2 residents reviewed with a Foley Catheter. Resident #55 and Resident #89 had incomplete documentation of Intake and Output. The findings included: The facility admitted Resident #55 with [DIAGNOSES REDACTED]. Record review on 06-18-14 at approximately 10 AM of the Cumulative Physician's Orders dated 05-01-14 through 05-31-14 and 04-01-14 through 04-30-14 revealed the following orders, Foley Catheter care every shift second to Sacral Decubitus and Intake and Output (I&O) every (q) shift. Further record review on 06-18-14 of the Intake and Output Monitoring Log for April 2014 revealed the following omissions: 04-06-14: 3p-11p output 04-09-14: 3p-11p intake and output 04-10-14: 3p-11p intake and output 04-11-14: 11p-7a intake and output, 3p-11p output 04-12-14: 11p-7a intake and output 04-13-14: 3p-11p intake and output 04-14-14: 11p-7a intake and output, 3p-11p intake and output 04-15-14: 3p-11p intake and output 04-17-14: 7a-3p intake and output, 3p-11p intake and output 04-18-14: 3p-11p intake and output 04-20-14: 11p-7a intake and output, 7a-3p intake and output 04-21-14: 7a-3p intake and output, 3p-11p intake and output 04-22-14: 3p-11p intake and output 04-24-14: 3p-11p intake and output 4-25-14: 3p-11p output 04-28-14: 3p-11p intake and output 04-29-14: 3p-11p intake and output Additional record review on 06-18-14 of the Intake and Output Monitoring Log for May 2014 revealed the following omissions: 05-01-14: 3p-11p output 05-02-14: 3p-11p output 05-07-14: 3p-11p output 05-09-14: 7a-3p output 05-12-14: 11p-7a output 05-13-14: 3p-11p intake and output 05-22-14: 7a-3p output 05-25-14: 7a-3p output 05-26-14: 11p-7a intake and output 05-31-14: 7a-3p intake and output During an interview on 06-18-14 with the Corporate Consultant, h/she, after record review, verified the omissions on the April 2014 and May 2014 Intake and Output Monitoring Logs and further confirmed Resident #55 had a Foley Catheter. Review on 06-18-14 of the facility policy titled Intake and Output revealed the following, The following residents may require measurement and documentation of intake and output at the end of each shift: 1.) Residents with an indwelling catheter (output required). i.e The output of residents with indwelling catheters is determined at the end of each shift. The facility admitted Resident #89 with [DIAGNOSES REDACTED]. Record review on 6/18/14 revealed a current physician's order dated 5/30/14 for intake and output. Review of the current care plan revealed an approach to monitor intake and output every shift with a start date of 3/14/14. Review of the Intake and Output Monitoring Log for March 2014, April 2014 and May 2014 revealed multiple times intake and output was not monitored/recorded as follows: March 2014 March 1, 2014-11p-7a intake; 7a-3p intake/output March 2, 2014-7a-3p intake/output March 9, 2014- 3p-11p intake/output March 10, 2014-11p-7a-intake/output March 11, 2014-11p-7a-output March 15, 2014-11p-7a-ouput; 3p-11p intake/output March 16,2014 11p-7a-intake/output March 21, 2014-3p-11p-ouput March 22, 2014-7a-3p-intake/output March 23, 2014-7a-3p-intake/output March 24, 2014 11p-7a-ouput March 25, 2014-3p-11p-intake/output March 27, 2014-3p-11p-intake/output March 31, 2014-7a-3p-intake/output and 3p-11p-intake/output April 6, 2014-7a-3p-intake/output April 10, 2014-11p-7a-output April 11, 2014-11p-7a-intake/output and 7a-3p-output April 12, 2014-11p-7a-intake/output April 26, 2014-3p-11p-intake/output April 27, 2014-11p-7a-intake/output and 3p-11p-intake-output April 28,2014-11p-7a-intake/output May 4,2014-11p-7a-intake/output May 10, 2014-3p-11p-intake/output May 11, 2014-intake/output not documented for all three shifts May 12, 2014-11p-7a-intake/output May 13,2014-11p-7a-intake/output May 16, 2014-11p-7a-intake/output May 21, 2014-11p-7a-output May 24, 2014 11p-7a-output May 25, 2014-7a-3p-intake/output On 6/19/14, the Nurse Consultant reviewed the Intake and Output Logs and confirmed the lack of documentation. During an interview with the Director of Nursing on 6/29/14 at 3:55 PM, he/she stated the expectation of the nurses was to sign Treatment Administration Records and to complete Intake and Output Logs. 2017-12-01
6586 FLORENCE REHAB & NURSING CENTER 425163 133 WEST CLARKE ROAD FLORENCE SC 29501 2014-06-19 322 D 0 1 T4HW11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the day of the survey based on observation, record review and interview it was determined the facility failed to ensure that Resident# 46, fed via gastrostomy tube, received the appropriate amount of tube feeding as ordered by the physician. Resident #46 was not provided the volume of tube feeding as ordered. (1 of 2 sampled residents reviewed with gastrostomy feedings) The findings included: Resident #46 was admitted to the facility with a gastrostomy (feeding) tube. Review of current physician's orders [REDACTED]. Observation of Resident #46 on 6/16/14 and 6/17/14 revealed the resident receiving a tube feeding of [MEDICATION NAME] 1.5 at 65ml/hr (milliliters per hour) Observation on 6/18/14 at 9:00am revealed Resident #46 lying in bed receiving [MEDICATION NAME] 1.5 at 65ml/hr and there was a little over 1400cc/ml left in the bottle that had been started at 2:00 am per bottle label. During an observation on 6/19/2014 at 1:30 pm Resident #46 lying in bed. Documentation on the bottle indicated [MEDICATION NAME] 1.5 cal (calorie) 1500cc was hung at 5am on 6/19/14 . Further observation revealed the resident's tube feeding was currently running, however, no feeding appeared missing from the bottle. Interview with LPN's (Licensed Practical Nurse) #4 and #2 on 6/19/14 at approximately 1:30 pm revealed night shift was responsible to hang the feedings. Further interview revealed LPN #4 had given Resident #46 his/her afternoon medications but had not noticed the bottle of feeding remained full. LPN's #2 and #4 verified it appeared the resident had not received any feeding thus far on 6/19/14. 2017-12-01
6587 FLORENCE REHAB & NURSING CENTER 425163 133 WEST CLARKE ROAD FLORENCE SC 29501 2014-06-19 323 E 0 1 T4HW11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review, interview, and observation, the facility failed to maintain appropriate fall prevention measures as ordered for 2 of 3 residents reviewed for accidents/hazards. Resident #44's devices to prevent falls were not working appropriately and #73 did not have devices in place to prevent falls. The findings included: The facility admitted Resident #44 with [DIAGNOSES REDACTED]. Review of the resident's record on 6/18/14 revealed Fall Risk Assessments which documented the resident was a high risk for falls. Review of the Quarterly Minimum (MDS) data set [DATE] revealed the resident was independent in bed mobility, transfer, walking in room and locomotion on the unit. The Resident required limited assistance of one person walking in the corridor and extensive assist with one person for locomotion off of the unit. Resident # 44 was coded as having an impairment to the upper and lower extremity on one side. Review of the facility provided incident reports for Resident # 44 revealed the resident had sustained three falls in May 2014 and one fall in June 2014. The resident's care plan for falls revealed multiple interventions including anti-rollbacks on w/c(wheel-chair). On 6/18/14 at 4:40 PM, the DON (Director of Nursing) was asked if the anti-rollbacks were functioning. He/she confirmed they were not functioning properly and this had been discovered on Monday (6/16/14) and wheels for the wheel-chair had been ordered. On 6/19/14 at 4:08 PM, the facility Consultant was asked if the anti-rollbacks were working properly. During a demonstration with the resident standing up and sitting back in the wheel-chair, the Consultant stated the anti-rollbacks were not working properly and this was confirmed by a staff member from the therapy department. The facility admitted Resident #73 with [DIAGNOSES REDACTED]. Review of the resident's record on 6/18/14 revealed Fall Risk Assessments which indicated the resident was a high risk for falls. Review of the most recent Annual Minimum (MDS) data set [DATE] documented the resident needed limited assist with one person in the areas of transfer and locomotion off the unit. Supervision with set up help only was required for walking in the room/corridor and locomotion on unit. Review the facility provided incident reports revealed the resident had sustained two falls in 2014 and multiple interventions were listed on the care plan. Anti-rollbacks and a dycem were suggested after falls in 2013 per review of the incident reports. Observation of the resident on 6/18/14 revealed only one anti-rollback was noted on the resident's chair and dycem was not under the cushion in the resident's chair. On 6/18/14 at 2:43 PM, the Unit Manager observed the resident's wheelchair with the surveyor and confirmed only one anti-rollback was on the resident's wheelchair and no dycem was noted. During an observation on 6/19/14 at 9:11 AM anti-rollbacks were noted on the resident's wheelchair but there was no dycem under the cushion of the seat of the chair under the cushion. During an interview with the Assistant Director of Nursing on 6/19/14 at 1:33 PM, s/he verified the resident does sit in the wheelchair at times. 2017-12-01
6588 FLORENCE REHAB & NURSING CENTER 425163 133 WEST CLARKE ROAD FLORENCE SC 29501 2014-06-19 333 E 0 1 T4HW11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on observation, record review and interview, the facility failed to administer medications as ordered resulting in significant medication errors for 2 of 2 [MEDICAL TREATMENT] residents. The facility failed to administer extended release metaprolol as ordered for Resident #122. [MEDICATION NAME] was not administered per ordered parameters for Resident #117. The findings included: Record review on 6-17-14 at 3:25 PM revealed the facility admitted Resident #122 with [DIAGNOSES REDACTED]. The resident was hospitalized from 6-7-14 to 6-9-14 for Volume Overload and Exacerbation of [MEDICAL CONDITION] and from 6-12-14 to 6-14-14 for [MEDICAL CONDITION]. Review of the 6-14-14 hospital Discharge Summary on 6-17-14 at 4 PM revealed Resident #122 was discharged with all of his (her) preadmission med(ication)s, including [MEDICATION NAME] XL 100 mg (milligrams) extended release 1 (one) every day. The accompanying Universal Medication Form (Discharge Medication List) also noted the resident was to take [MEDICATION NAME] ([MEDICATION NAME] XL) 100 mg 1 tablet Extended Release 24 h(ou)r. l tablet oral daily at noon. Record review revealed handwritten physician's orders [REDACTED]. The order did not indicate that the extended release type of the medication should be administered. Review of the Medication Administration Record (MAR) revealed that this medication was given on 6-4, 5, 6, 10, 11, 12, 15, 16, 17, 2014 for a total of nine days/doses. Further review with LPN #3 and LPN #5 revealed that the medication cart contained [MEDICATION NAME] 100 mg, not [MEDICATION NAME]/not the [MEDICATION NAME] XL that was ordered. Both nurses verified the content of the cart at 6-17-14 at 4:30 PM. After reviewing and confirming the physician's transfer orders, LPN #3 stated s/he would write a clarification order and notify the physician. Review of Daily Skilled Nurse's Notes on 6-17-14 at 4:40 PM revealed that the 7 AM-3 PM shift that day had documented an untimed BP of 68/34. When questioned, the 3-11 PM Licensed Practical Nurse (LPN) #6 and LPN #3 were unaware of the low BP. When asked about what the BP reading was that afternoon, the nurses obtained a result of 80/60 from the Certified Nursing Assistant. Further review of Daily Skilled Nurse's Notes revealed a BP of 80/60 recorded on the evening shift on 6-12-14. The next BP recorded was taken at approximately 5:30 PM prior to the resident being sent to the emergency room when noted to be anxious, SOB (short of breath), + having labored breathing .80/62 . During an interview on 6-18-14 at 9:15 AM, LPN #5 stated s/he gets the BP at anytime during the shift from the CNA (Certified Nursing Assistant) and that the BP was not taken prior to antihypertensive medication. The nurse also noted that the physician had discontinued the medication when notified of the low BP on 6-17-14. Record review on 6-18-14 revealed the facility admitted Resident #117 with [DIAGNOSES REDACTED]. 4-26-14 Hospital discharge medications included: [MEDICATION NAME] 25 mg PO one tab QD (daily). Hold if BP Review of Daily Skilled Nurse's Notes from 4-26-14 through the dates of the survey revealed that the systolic BP was less than 135 on the day shift as follows: 4-27-14=112/62, 4-28-14=100/60, 4-29-14=110/68, 4-30-14=121/62, 5-1-14=110/70, 5-2-14=101/64, 5-3-14=110/80, 5-4-14=108/70, 5-5 14= 100/62, 5-6-14=130/60, 5-7-14=110/60, 5-8-14=108/60, 5-10-14=110/70, 5-11-14=126/72, 5-13-14=110/72, 5-14-14=130/70, 5-15-14=131/68, 5-22-14=114/60, 5-31-14=103/60, 6-1-14=130/60, 6-3-14=110/58, 6-5-14=132/80, 6-7-14=130/70, 6-9-14=110/60, 6-10-14=130/70, 6-12-14=128/74. During an interview on 6-18-14 at 9:15 AM, LPN #5 stated s/he gets the BP at anytime during the shift from the CNA (Certified Nursing Assistant) and that the BP was not taken prior to antihypertensive medication. During an interview on 6-19-14 at 11:27 AM, the DON confirmed that the nurse neglected to transcribe the parameters for administration of the medication. 2017-12-01
6589 FLORENCE REHAB & NURSING CENTER 425163 133 WEST CLARKE ROAD FLORENCE SC 29501 2014-06-19 371 E 0 1 T4HW11 On the days of the survey, based on observation, interview, and review of facility policy Nourishments, and Sanitation and Infection Control the facility failed to remove expired nutritional supplements from the medication/supplement storage area for 1 of 3 medication/supplement storage rooms. The deficient practice had the potential to affect all residents receiving this nutritional supplement who resided on the unit. Additionally, the facility failed to serve/distribute food in a sanitary manner, as evidenced by random observations of staff touching bread products with their bare hands. (2 of 3 units observed during meal delivery.) The findings included: On 6/16/14 at 11:20 AM, an observation of the Central Hall medication/supplement storage area with LPN #1 and the Director of Nursing (DON) revealed 3 (32 Fluid Oz./ 946 mL) unopened cartons and 1 opened (approximately 8 Oz.) of Lyons Ready Care No Sugar Added NSA 1.7 High Calorie High Protein Supplement Drink Vanilla (Lot # 4323-D), with a use by date of 5/22/14. LPN # 1 and the DON verified the date and indicated that they should have been removed from use. Review of the facility policy entitled Nourishments, under section Instructions unopened/thawedstated: Shelf stable, monitor manufacture expiration date. During a random observation of the lunch meal on 6/16/14 at 12:33 PM, CNA (Certified Nursing Assistant) #3 was noted to touch two resident's bread with his/her bare hand when applying butter to the bread. During an observation on 6/18/14 at 12:25 PM, CNA #1 touched cornbread with his/her bare hand while applying butter to the bread while serving a resident's meal. During an interview with CNA #1 on 6/18/14 at 4:04 PM, he/she confirmed the cornbread had been touched with his/her bare hand and s/he stated s/he was trying not to let the cornbread fall apart. A random observation on 06-16-14 at approximately 12:32 PM of the Center Hall lunch meal distribution revealed Licensed Practical Nurse (LPN) #3 failed to sanitize his/her hands, cut a resident's sandwich in half, and proceeded to place the sandwich into a plastic bag using bare hands. A second random observation on 06-18-14 at approximately 12:58 PM of the Center Hall lunch meal distribution revealed Certified Nursing Assistant (CNA) #2 opened a pack of crackers and placed them with his/her bare hands onto the resident's plate. During an interview on 06-19-14 with LPN #3, s/he verified s/he had failed to sanitize his/her hands and had touched the resident's bread with his/her bare hands. CNA #2 was unavailable for interview. Review of the facility policy titled Sanitation and Infection Control revealed in Procedure: #2. the following, Avoid touching food with bare hands .i.e If direct contact with food is necessary always have clean, washed hands and limit contact to minimal. 2017-12-01
6590 FLORENCE REHAB & NURSING CENTER 425163 133 WEST CLARKE ROAD FLORENCE SC 29501 2014-06-19 431 E 0 1 T4HW11 On the days of the survey, based on observations, interview, and review of the facility policy Storage of medications, the facility failed to follow a procedure to ensure that expired medications were removed from medication storage in 1 of 3 medication carts. The findings included: On 6/16/14 at 11:20 AM, an observation of the Central Hall medication cart with LPN #1 revealed (12) single dose packaged tablets of Acetaminophen 500 milligram (mg) (Lot Number # ). All tablets had an expiration date of 12/18/13. Following the observation LPN #1 and the Director of Nursing (DON) verified the (12) tablets of Acetaminophen were expired and indicated that the medication should have been removed from the cart. Review of the facility policy entitled Storage of Medications, section (M) of Procedures states Outdated, contaminated, or deteriorated medications and those in containers that are cracked, soiled, or without secure closures are immediately removed from stock, disposed of according to procedures for medication disposal and reordered from the pharmacy, if a current order exists. 2017-12-01
6591 FLORENCE REHAB & NURSING CENTER 425163 133 WEST CLARKE ROAD FLORENCE SC 29501 2014-06-19 504 E 0 1 T4HW11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interviews, the facility obtained laboratory tests without a physician's orders for one of seventeen sampled residents reviewed for provision of laboratory services. (Resident #82) The findings included: Record review on 6-18-14 at 5:30 PM revealed that the facility admitted Resident #82 with [DIAGNOSES REDACTED]. Record review on 6-19-14 at 8:30 AM revealed Physicians Orders for BMP (Basic Metabolic Profile) every 6 mo(nths), PAB ([MEDICATION NAME]) every month, and [MEDICATION NAME] every 6 months. Review of lab reports revealed that the BMP was drawn and reported on 6-20-13 and 6-21-13. No orders could be located for the second tests that were done in 6-13. The PAB was drawn on 1-2-14 and 1-15-14. No orders could be located for the second test done for that month. The [MEDICATION NAME] level was done on 5-9-14, 1-15-14, 1-2-14, 12-24-13, and 6-20-13. No orders could be located for the two tests that were done in 1-14. Further review revealed laboratory reports for a 5-12-14 urine culture and sensitivity and a 1-15-14 Hemoglobin and Hematocrit for which no physician's orders could be located. During an interview on 6-19-14 at 10:53 AM, the Director of Nurses and Registered Nurse Consultant reviewed the medical record. No physician's orders were located for the above-listed labs. 2017-12-01
6592 FLORENCE REHAB & NURSING CENTER 425163 133 WEST CLARKE ROAD FLORENCE SC 29501 2014-06-19 505 E 0 1 T4HW11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record review and interviews, the facility failed to promptly notify the attending physician of abnormal laboratory test results so that appropriate action might be taken if indicated for two of seventeen sampled residents reviewed for provision of laboratory services out of a total of 22. (Residents #9 and #82) . The findings included: Record review on 6-18-14 at 5:30 PM of laboratory reports and Nursing Progress Notes for Resident # 82 revealed no evidence that the physician had been notified of abnormal test results for the following: -[MEDICATION NAME] level done on 8-21-13; -Complete Blood Count (CBC) done on 8-20-13, 2-25-14; -[MEDICATION NAME] on 3-25-14 , 2-25-14, 1-2-14, 11-11-13; -Hemoglobin and Hematocrit on 1-15-14; -[MEDICATION NAME] level on 1-2-14, 12-24-13. Record review on 6-18-14 at 2:17 PM revealed the facility admitted Resident #9 with [DIAGNOSES REDACTED]. Review of laboratory reports and Nursing Progress Notes revealed no evidence that the physician had been notified of abnormal test results for the following: -CBC done on 1-15-14; -Basic Metabolic Profile on 12-18-13; -[MEDICATION NAME] level on 1-15-14. During an interview on 6-18-14 at 4:20 PM, the Director of Nurses stated that nurses should note on the lab report that the physician was faxed or notified of results. When asked if the information could be documented elsewhere, s/he stated, The only other place could be in nurses' notes. During an interview on 6-19-14 at 10:53 AM, the Director of Nurses and Registered Nurse Consultant reviewed the medical record. No evidence of physician notification related to lab results could be located. 2017-12-01