Albertville Nursing Home

Inspectors wroteBased on interviews, record reviews and a facility policy titled Comprehensive Person Centered Careplanning/ Baseline Careplan, the facility failed to ensure RI (Resident Identifier) RI #125 received a copy of his/her Baseline Careplan Summary within 48 hours of admission. The facility further failed to ensure RI #350's Baseline CarePlan was developed within 48 hours of admission. This deficient practice affected two out of six sample residents whose baseline care plans were reviewed. A review of a facility policy titled Comprehensive Person Centered Careplanning / Baseline Careplan, dated 11/28/17 document: . Procedure 1. Care will be customized based on the resident needs and values within 48 hours of admission. 3. The interdisciplinary team will work together to develop a baseline care plan within 48 hours of admission . 6. Provide the resident and the resident representative, . [...]

Inspectors wroteBased on interviews, record reviews and a review of the document titled, Centers for Medicare & (and) Medicaid Services, the facility failed to ensure Resident Identifier (RI) #1, #2, #3, #5, #25, #36, and #38's Minimum Data Set (MDS) Assessments were transmitted in a timely manner. This affected nine of nine residents reviewed for MDS transmissions. Findings Include: A review of the document titled, Centers for Medicare and Medicaid Services Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual, Version 1.15, [DATE], Chapter 2 Assessment for the Resident Assessment Instrument (RAI), page 2-20 revealed: . The MDS must be transmitted (submitted and accepted) into the the MDS database electronically no later than 14 calendar days after the care plan completion date. A review of resident medical records revealed: [...]

Inspectors wroteBased on interview, medical record review and the Resident Assessment Instrument User Manual Version 3.0 Chapter 4, the facility failed to ensure RI ( Resident Identifier)'s #16 and #95 attended their care plan conferences so that they were involved in making decisions about their care and treatment. The deficient practice affected two of two sample residents whose care plan attendance forms was reviewed. Findings Include: A review of a document, Resident Assessment Instrument User Manual Version 3.0, revealed: . Chapter 4: .CARE PLANNING .4.7 Care Planning A well developed .care plan: .Reflects the resident/resident representative input and goals for health care: . The overall care plan should be orient towards .Involving resident, . RI # 95 was admitted readmitted to the facility on [DATE]. [...]

Inspectors wroteBased on observation, interviews, record review, and a review of the facility's policy titled, Quality of Life; Dignity, the facility failed to ensure a Certified Nursing Assistant (CNA), Employee Identifier (EI) #1, transported Resident Identifier (RI) #8 to the shower and maintained his/her dignity. This affected one of five sampled residents observed for incontinence care. Findings Include: A review of the facility policy titled, QUALITY OF LIFE; DIGNITY revealed: . 9. shall promote, maintain and protect resident privacy, including bodily privacy during assistance with personal care and during treatment procedures. Demeaning practices and standards of care that compromise dignity are prohibited. Staff shall promote dignity and assist residents as needed. [...]

Inspectors wroteBased on staff interviews, medical record review, and review of Centers for Medicare & Medicaid Services (CMS), Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User's Manual Version 1.13 October 2015, the facility failed to ensure Resident Identifier (RI) #9's Quarterly Minimum Data Set (MDS) assessments dated 05/02/2017 and 07/25/2017 were accurately coded for Oxygen (O2) use. This deficient practice affected RI #9, one of 20 sampled residents whose MDS assessments were reviewed. Findings Include: A review of CMS's RAI 3.0 Manual revealed: .Special Treatments, Procedures, and Programs . Planning for Care . Reevaluation of special treatments . [...]

Inspectors wroteBased on observation, interviews, review of job descriptions of the Director of Food Services, Speech Therapist and Dietician, a review of a facility document titled, CARE PLAN FEEDING TUBE, and review of the medical record, the facility failed to ensure Resident Identifier (RI) #12's care plan was revised to reflect an alteration requested by RI #12's spouse to the ordered pureed diet. This affected RI #12, one of 21 sampled residents. Findings Include: Review of a facility document titled, CARE PLAN FEEDING TUBE dated, 9/13/17 documented the following: Problem . Receives Puree diet w/ (with) honey-liquids & (and) nosey cup . Approaches . B (breakfast), L (lunch), D (dinner) meals trays to be sent Review of the Dietitian job description, with no date, revealed the following: . [...]

Inspectors wroteBased on observation, interviews, and medical record review, the facility failed to ensure a physician's order for Resident Identifier (RI) #12's diet was obtained and written to include an alteration to the pureed diet at spouse's request. The facility also failed to ensure an order for honey consistency liquids was followed. This affected RI #12, one of 13 sampled residents whose diet orders were reviewed. Findings Include: RI #12 was readmitted to the facility on [DATE] with diagnoses to include Persistent Vegetative State, Unspecified Convulsions and Intracranial Injury Without Loss of Consciousness. Review of RI #12's Annual Minimum Data Set (MDS) assessment with an Assessment Reference Date (ARD) of 07/18/17, documented the resident as total dependence with two plus persons physical assistance for Activities of Daily Living (ADLs). [...]

Inspectors wroteBased on observations, interviews, review of facility policies titled, Incontinence Care Bowel, DRESSING CHANGES, and HANDWASHING, the facility failed to ensure: 1. a nurse did not remove tape and a permanent marker from her pocket after washing her hands, placed the tape to be used on Resident Identifier (RI) #5's dressings on an unclean night stand and then, apply gloves to begin wound care, 2. a nurse washed her hands and changed gloves after removing a soiled dressing and before applying a clean dressing for RI #5, 3. a nurse washed her hands and changed gloves when moving from a wound on RI #5's left heel and without washing her hands, removed the soiled dressing from RI #5's right heel, and 4. a Certified Nursing Assistant (CNA) did not transport RI #8 to the shower in a shower chair, without a waste receptacle in place, causing urine and fecal matter to be dropped in the hallway. [...]

Inspectors wroteBased on observation, interviews and record review, the facility failed to provide evidence inservice education was provided to Certified Nursing Assistants (CNA) related to alterations in pureed diets. This affected Resident Identifier (RI) #12 and had the potential to affect all seven residents in the facility receiving altered pureed diets. Findings Include: RI #12 was readmitted to the facility on [DATE] with diagnoses to include Persistent Vegetative State, Unspecified Convulsions and Intracranial Injury Without Loss of Consciousness. On 9/20/17 at 8:01 a.m., the surveyor observed RI #12's breakfast tray to contain scrambled eggs, oatmeal and a bowl of gravy with a whole biscuit on top of the gravy. After the biscuit was mashed into the gravy by a CNA, there were still visible pieces of biscuit observed in the bowl. [...]