Adamsville Healthcare and Rehabilitation Center

Inspectors wroteBased on observation and interview, the facility failed to ensure kitchen sanitation when a black slimy substance was found inside 1 of 3 (500-hall ice machine) ice machines observed. There were 8 residents on the 500-hall who had the potential to be affected.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to follow physician orders and to monitor the oxygen flow rate for 2 of 2 (Resident #11 and #27) sampled residents reviewed for respiratory therapy.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to ensure practices to prevent the potential spread of infection were maintained when 1 of 5 nurses (Licensed Practical Nurse (LPN) A) failed to disinfect reusable resident equipment for 1 of 5 (Resident #61) residents observed during medication administration.

Inspectors wroteBased on review of the Geriatric Medication Handbook, medical record review, observation, and interview, the facility failed to ensure residents were free from significant medication errors when 1 of 6 nurses (Licensed Practical Nurse (LPN) #1) failed provide a substantial snack or meal within 15 minutes of insulin administration for Resident #60. The failure to provide a substantial snack or meal within 15 minutes of insulin administration resulted in a significant medication error.

Inspectors wroteBased on observation and interview, the facility failed to ensure opened medications were properly labeled and dated, external and internal medications were not stored together, and medications were not stored past their expiration date in 4 of 11 medication storage areas (100/200 Hall Medication Cart, 200/500 Hall Medication Cart, 400 Hall Medication Cart, and 400 Hall Treatment Cart).

Inspectors wroteBased on policy review, observation, and interview, the facility failed to ensure food was distributed and served in a sanitary manner when 1 of 11 staff members (Certified Nursing Assistant (CNA) #2 ) did not perform hand hygiene between serving residents and after touching contaminated surfaces, and placed dirty meal trays in a clean meal cart with other residents' meal trays.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to provide and maintain a sanitary and comfortable environment as evidenced by strong malodorous odors on 1 of 5 halls (200 Hall).

Inspectors wroteBased on observation and interview, the facility failed to provide privacy during 1 of 1 meeting with active Resident Council members.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to maintain or enhance resident dignity and respect when 5 of 23 (Certified Nursing Assistant (CNA) #1, #4, #6, #7, and #9) facility staff members referred to clothing protectors as bibs, did not use courtesy titles to address residents, used a personal cell phone while assisting a resident with a meal, stood over a resident to assist with a meal, and failed to knock before entering a resident's room.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to ensure the survey results were readily accessible for all residents residing in the facility. The facility had a census of 98 residents.

Inspectors wroteBased on policy review, medical record review, observation, and interview, 1 of 2 nurses (Licensed Practical Nurse (LPN) # 4) failed to follow facility policy for administration of medications through a percutaneous endoscopic gastrostomy (PEG) tube (a tube inserted into the stomach for nutrition and medication) when medications were pushed through the enteral tube and not allowed to flow per gravity.

Inspectors wroteBased on medical record review, observation, and interview, the facility failed to follow the physician's orders for wound care treatments for 1 of 4 (Resident #70) sampled residents reviewed for wound care.

Inspectors wroteBased on medical record review, review of the facility staffing schedules and interview, it was determined the facility failed to provide sufficient staffing to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. The facility had a census of 98 residents.

Inspectors wroteBased on review of the PHYSICIANS' DESK REFERENCE 69th EDITION, medical record review, observation, and interview, the facility failed to ensure medications administered were appropriately monitored for adverse effects for 1 of 6 (Resident #16) sampled residents reviewed for unnecessary medications.

Inspectors wroteBased on policy review, review of the JoVE Science Education Database Nursing Skills. Preparing and Administering Intramuscular Injections, medical record review, observation, and interview, the facility failed to ensure 2 of 8 (Licensed Practical Nurse (LPN) #2 and #3) nurses administered medications with a medication error rate of less than 5 percent (%). A total of 2 errors were observed out of 29 opportunities, resulting in an error rate of 6.89%.

Inspectors wroteBased on review of the 2018 Boehringer Ingelheim Pharmaceuticals, Inc. manufacturer's information, policy review, medical record review, and interview, the facility failed to ensure medications were administered free from significant medication errors for 1 of 24 (Resident #70) sampled residents.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to ensure medications were properly stored when 1 of 9 (500 Lower Hall Medication Cart) medication storage areas was unlocked and unattended.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to ensure food was stored, prepared and served under sanitary conditions as evidenced by a dirty hand-washing sink in the Kitchen, dishwashing racks stored on the floor in the Kitchen, opened, unlabeled and undated foods stored in the Kitchen and in 1 of 3 (100/200 Hall Nourishment Room) nourishment rooms, wet towel on the floor in the Kitchen, a dirty steam table in the Kitchen, raw chicken and frozen foods left sitting at room temperature in the Kitchen, and foods on the floor in the Kitchen. The facility had a census of 98 residents, with 91 of those residents receiving a meal tray from the kitchen.

Inspectors wroteBased on the Resident Assessment Instrument (RAI) Manual, policy review, medical record review, observation, and interview, the facility failed to ensure accurate documentation related to pressure ulcers for 1 of 4 (Resident #31) sampled residents reviewed for pressure ulcers and medication administration related to insulin and intravenous (IV) antibiotics for 2 of 6 (Resident #59 and #61) sampled residents reviewed for unnecessary medications.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to ensure practices to prevent the potential spread of infection were maintained when isolation precautions were not followed for 1 of 2 (Resident #49) sampled residents reviewed and facility staff failed to protect resident's personal clothing from environmental contamination.