Aspire Physical Recovery Center at Cahaba River

Inspectors wroteBased on interviews, Resident Identifier (RI) #264's medical record, FUNDAMENTALS OF NURSING NINTH EDITION, the facility's PROTOCOL FOR EMERGENT CARE, the facility policy titled Cardio Pulmonary Resuscitation (CPR), and a facility reported incident received by the Alabama State Survey Agency, the facility failed to honor the end-of-life wishes of RI #264, a resident with an Advanced Directive to withhold resuscitative measures in the event of cardiopulmonary cessation and an active physician's order for DNR (Do Not Resuscitate) code status. The DNR order directed staff to not initiate CPR when the resident stopped breathing and/or their heart stopped beating. During the evening shift on [DATE], RI #264 was found unresponsive with no pulse or respirations. [...]

Inspectors wroteBased on observations, interviews, medical records, and the facility policy titled Food Preparation Guidelines, the facility failed to ensure food was served at an appetizing temperature. Specifically, on 01/11/2024 during the breakfast meal, the eggs were not served at an appetizing temperature. This had the potential to affect 108 of the 109 residents receiving the breakfast meal from the facility's kitchen.

Inspectors wroteBased on observations, interviews, residents' medical records, and the facility policy titled Federal Rights of Residents, the facility failed to ensure staff did not stand while feeding Resident Identifier (RI) #101 the lunch meal on 01/10/2024; and RI #91 the lunch meal on 01/11/2024. This deficient practice affected RI #101 and RI #91; two of four sampled residents observed being assisted with meals.

Inspectors wroteBased on interviews, record review, and the facility policy titled, Person Centered Care Plan, the facility failed to ensure Resident Identifier (RI) #34 and his/her representative was informed of RI #34's quarterly care plan meetings scheduled for August and November of 2023. This affected RI #34, one of 27 residents sampled for the right to participate in care planning.

Inspectors wroteBased on interviews, observations, resident's medical record, and the facility policy titled, . Self-Administration of Medications, the facility failed to ensure Medical Assistant Certified (MAC) #11 and License Practical Nurse (LPN) #12 did not leave the room while Resident Identifier (RI) #54 received nebulizer treatments. RI #54 had not been assessed for the ability to self-administer medication. This deficient practice affected RI #54; one of three residents sampled for receiving nebulizer treatments.

Inspectors wroteBased on interviews, observations, residents' medical records, and the facility policy titled, Person Centered Care Plans, the facility failed to ensure Resident Identifier (RI) #54 and RI #314 had a care plan developed for the use of their oxygen. This deficient practice affected RI #54 and RI #314, two of 25 residents whose care plans were reviewed.

Inspectors wroteBased on interviews, observation, residents' medical records, and the facility policy titled, Oxygen Administration, the facility failed to ensure Resident Identifier (RI) #54's nebulizer mask was covered when not in use. The facility further failed to ensure RI #314's and RI #85's oxygen tubing was labeled/dated. This deficient practice affected RI #54, one of three residents reviewed for proper storage of respiratory supplies; and RI #314 and RI #85, two of three residents reviewed for respiratory care.

Inspectors wroteBased on RI #215's medical record, interviews, facility pharmacy records titled CONSOLODATED DELIVERY SHEETS, and the facility policy titled, Ordering and Receiving Medications from Provider Pharmacy the facility failed to ensure Resident Identifier (RI) #215's Clonazepam was available for administration on 04/05/2023, 04/06/2023, 04/07/2023, and 04/11/2023. This deficient practice affected RI #215; one of three residents sampled for medication availability.

Inspectors wroteBased on observation, interview, and the 2017 Food and Drug Administration (FDA) Food Code, the facility failed to ensure: 1.) the dishwasher drain pipe did not extend into the floor drain by one inch, 2.) the table stand mixer's wire bowl guard did not have a white-yellow dried residue on the bottom wire when the cook used the mixer to make chocolate pudding for lunch on 9/17/19, and 3.) the Tuna Salad, Pasta Salad, and Oreo Fluff Parfait served for lunch on 9/17/19 were maintained at 41 degrees Fahrenheit (F) or lower during holding for service. This had the potential to affect 99 residents receiving meals from the kitchen, 99 of 100 residents.

Inspectors wroteBased on observation, interview, and the 2017 Food and Drug Administration (FDA) Food Code, the facility failed to ensure one of two dumpster's had the doors closed and further failed to ensure the outside refuse storage area was kept clean to discourage vermin. This had the potential to affect 100 out of 100 residents living in the facility.

Inspectors wroteBased on observation, interview, the facility's Cycle Menus policy, the facility's Menu Changes policy, the facility's Menu Diet Guide Sheet, and the facility's Menu Measurement Conversion Factors, the facility failed to ensure the planned lunch menus for the Pureed and the Mechanical Soft diets were followed on Tuesday, 9/17/2019. This had the potential to affect the eighteen residents receiving mechanically altered diets, eighteen of 99 residents receiving their meals from the kitchen and eighteen of 100 residents in the facility.

Inspectors wroteBased on the facility's policy titled, Tube Feeding-Formula Documentation, observation and interviews, the facility failed to ensure Resident Identifier (RI) # 87's tube feeding pump water flush rate was set at 80 cubic centimeter (cc) an hour (per the physician orders), and not set at 50 cc an hour. The failed practice affected one of two residents receiving tube feeding.

Inspectors wroteBased on observation, interview, resident tray tickets, medical record review, and a review of the facility's policies for Person Centered Care Plans and Tray Tickets, the facility failed to ensure that requested or preferred food items were served to Resident Identifier (RI) #86 and RI #7 at lunch on 9/18/19. This affected two of 99 residents receiving meals from the kitchen, two of 100 residents residing in the facility.

Inspectors wroteBased on a facility's policy titled, Isolation Food Trays, observation and interviews, the facility failed to ensure a disposable tray was utilized for Resident # 22 on isolation for Clostridium difficile and was not served a meal on a non disposable meal tray on 09/18/19. The failed practice affected one of one resident who was on isolation.

Inspectors wroteBased on observations, interviews and a facility policy titled, Cleaning of Miscellaneous Equipment and Utensils, the facility failed to ensure: 1. a heavy build up of what appeared to be burnt on food particles was not on the double stack conviction oven and grill; 2. the ice machine did not have a build up of a dark black substance on the right and left sides of the inner plastic chute that reached from the right to left side; 3. the dish-washing machine did not have a heavy accumulation of brown substance/pieces around the edges on top of it; 4. the log with scheduled times for the temperatures of the dishwasher to be checked had been completed since breakfast on 8/14/18; and 5. the log with scheduled times for the sanitizing solution to be checked had been completed since breakfast on 8/14/18 Findings Include: The following observations were made on 08/13/18 05:15 PM: [...]

Inspectors wroteBased on observation and interviews, the facility failed to ensure a Licensed Practical Nurse (LPN) administered medications in a manner to prevent cross contamination. The LPN used a clip board filled with papers to transport medications from the medication cart into residents' rooms and placed the clip board on surfaces inside the residents' rooms. Further, the LPN placed her fingers inside medication cups and inside bags used for crushing medication. This affected Resident Identifier (RI) #s 11, 14, 30 and 53, four of nine residents observed during medication pass.

Inspectors wroteBased on review of SNF (Skilled Nursing Facility) Beneficiary Protection Notices and interview, the facility failed to ensure Resident Identifiers (RI) #44 and RI #47 were issued a Medicare Coverage/Liability Notice, as required. This deficient practice affected two of three residents reviewed for Notice of Medicare Non-Coverage. Findings Include: On 8/16/18 at 3:30 a SNF ( Skilled Nursing Facility) Beneficiary Protection Notification review was conducted. There was no documentation that RI #44 and RI #47 were issued a SNF, ABN Form which was required. On 8/16/18 at 3: 40 p.m., an interview was conducted with EI (Employee Identifier) #2, Manager for [NAME] and Collections. EI #2 was asked if RI #44 and RI #47 were issued a SNF-ABN form. EI#2 said, No. EI #2 was asked should RI #44 and RI #47 have been issued a SNF-ABN form. EI #2 said, yes, they should have been issued a SNF-ABN form. [...]