Attalla Rehabilitation and Nursing Center

Inspectors wroteBased on observations, interviews, review of facility policies titled, Water Temperatures, Safety Of and Management of the Laundry, review of facility Maintenance Repair Log sheets, review of facility Water Temp (temperature) Log Sheets, and review of the laundry department's Dryer Log, the facility failed to: 1) monitor and maintain safe hot water temperatures, which were found to be up to 145 degrees Fahrenheit (F), on all residential wings/units of the facility, including the dementia unit. Further, staff failed to implement the system for reporting and acting upon ongoing concerns related to excessively hot water in resident care areas. Specifically, direct care staff with knowledge of excessively hot water temperatures did not record this information on the facility's Maintenance Repair Log sheets as the concerns were identified. [...]

Inspectors wroteBased on interviews and review of the facility's, Administrator Job Description, administration failed to provide training and oversight to ensure the facility was free from the potential for injury related to identified concerns regarding elevated hot water temperatures. During the survey, the survey team identified hot water temperatures throughout all residential units/wings of the facility, including the Dementia Unit, that exceeded 110 degrees Fahrenheit (F). Temperatures were found to be as high as 145 degrees F in resident bathroom sinks, as well as resident shower rooms. This deficient practice placed all 89 residents in the facility in immediate jeopardy (IJ), as it was likely to result in serious injury, serious harm, serious impairment, or death. [...]

Inspectors wroteBased on observations, interviews, review of a facility policy titled, Water Temperatures, Safety Of, review of facility Maintenance Repair Log sheets, and review of facility Water Temp Log Sheet documents, the facility failed to monitor and maintain the water heating/boiler system in safe operating condition to prevent hazardous hot water temperatures. Water temperatures were observed in excess of 110 degrees Fahrenheit (F) on all residential wings/units of the facility, including the Dementia Unit. Temperatures as high as 145 degrees Fahrenheit (F) were observed in resident bathrooms and shower rooms throughout the facility. This deficient practice placed all 89 residents in the facility in immediate jeopardy (IJ), as it was likely to result in serious injury, serious harm, serious impairment, or death. [...]

Inspectors wroteBased on observations, interviews, review of the Food and Drug Administration (FDA) Food Code, and review of the facility's policies titled, Food: Preparation, Food Storage: Dry Goods, Food Storage: Cold Foods, Dispose of Garbage and Refuse, Warewashing, and Proper Hand Hygiene: Dining Services Employees, the facility failed to ensure: 1) one item was properly labeled and dated, and two items were used or disposed of by date on package; 2) five boxes of food were stored off the walk-in freezer floor; 3) soap was available for staff to wash hands at the only handwash sink in the kitchen; 4) opened bags of food in dry storage were closed, labeled, and dated; 5) the floor and shelves in dry storage are were clean from foods; 6) sanitizing buckets contained the appropriate concentration of sanitizer for cleaning the kitchen; [...]

Inspectors wroteBased on observations, interviews, review of facility policies titled, Management of the Laundry, Interim Recommendations for Routine & Terminal COVID-19 Isolation Room/Unit Cleaning, and review of the facility's Maintenance Repair Logs, the facility failed to ensure a safe, clean, comfortable, homelike environment for residents in the facility. Specifically, the facility failed to ensure: 1. housekeeping services were provided to prevent soiled floors, a soiled over bed table, and/or soiled resident care equipment in Resident Identifier (RI) #80's room; 2. sufficient linens, including bath towels and washcloths, were available for resident care on Units D, E, F, and G; 3. [...]

Inspectors wroteBased on observations, interviews, record reviews, and review of the facility's policies titled, Gastric Tube Feeding via Continuous Pump and Administering Medications through an Enteral Tube, the facility failed to ensure Resident Identifier (RI) #80 and RI #67 received services and treatment to prevent complications. Specifically, the facility failed to ensure: 1. RI #80's head of the bed (HOB) was elevated to a level of 30-40 degrees while the tube feeding pump was running and the Registered Nurse (RN) checked RI #80's tube feeding residual before administering medications through the gastrostomy tube (G-tube) and did not use a syringe to force a medication through RI #80's G-tube that had become clogged. In addition, staff failed to clean RI #80's gastrostomy tubing daily with soap and water and put a clean gauze to the site daily as ordered by the physician; and 2. [...]

Inspectors wroteBased on observations, interviews, record reviews, and review of facility policies titled, Administering Medication through an Enteral Tube, Administering Oral Medications, Insulin Administration, and review of the manufacturer's instructions for the Novolog insulin pen, the facility failed to maintain a medication error rate less than 5%. There were seven errors in 29 opportunities, which resulted in a 24% medication error rate for Resident Identifier (RI) #43, RI #78, and RI #80, three of four residents observed during medication pass. Specifically, the facility failed to ensure: 1. RI #80, who received medications via gastrostomy tube (G-Tube), was given complete doses of Calcitriol, Cymbalta and Prilosec as ordered by the physician. In addition, staff failed to dilute a liquid potassium chloride dose prior to administration; 2. [...]

Inspectors wroteBased on observations, interviews, and review of a facility policy titled, Storage of Medications, the facility failed to label and store medications in three of three medication carts and failed to ensure medications were secured in medications carts in accordance with acceptable principles. Specifically, staff failed to label medications upon opening with an open date and expiration date, and failed to ensure the G Unit medication cart did not contain loose pills inside the drawers. This was observed with opened medications belonging to 10 out of 89 residents in the facility.

Inspectors wroteBased on record review, interviews, and review of facility policies titled, Care of Fingernails/Toenails, and Shaving the Resident, the facility failed to ensure activities of daily living (ADL) care tasks related to nail care and shaving were provided for Resident Identifier (RI) #67. This deficient practice affected RI #67, one of three residents sampled for ADL care.

Inspectors wroteBased on observation, interviews, and record review, the facility failed to ensure Resident Identifier (RI) #139 received Gabapentin (Neurontin) as ordered, due to not having the medication available for administration. This failure affected one out of five sampled residents reviewed for pain management.

Inspectors wroteBased on observation, interview, record review, and review of a facility policy titled, End-Stage Renal Disease, Care of a Resident with, the facility failed to ensure Resident Identifier (RI) #140 received care and services related to dialysis that were consistent with professional standards. This deficient practice affected RI #140, one of two residents sampled for dialysis care and services.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medications were available for administration as ordered by the physician for Resident Identifier (RI) #139, one of five sampled residents reviewed for medication availability.

Inspectors wroteBased on interviews, review of Resident Identifier (RI) #58's medical record, the facility's policy titled Notification of Changes and a complaint received by the Alabama State Survey Agency, the facility's licensed nursing staff failed to notify RI #58's physician, responsible party and the facility's Administrative staff of the actual events that took place when RI #58 was found deceased in the facility on 4/18/2019. The licensed nursing staff was aware that RI #58 had received a Regular diet that consisted of a chicken sandwich instead of a Pureed diet, which was ordered for the resident. [...]

Inspectors wroteBased on interviews, review of the facility's policy titled Attalla Health and Rehab; Food and Nutrition Services, a complaint received by the Alabama State Survey Agency, Resident Identifier (RI) #58 and RI #136's medical records, the facility's diet spreadsheet, and investigation file, the facility failed to ensure RI #58 received a Pureed diet during the supper (dinner) meal on 4/18/2019. On 4/8/2016, RI #58, a cognitively impaired resident assessed by the facility as requiring set up help only with eating, was ordered a Pureed diet. RI #58 has a medical history to include a diagnosis of Sjogren's syndrome, which causes difficulty swallowing. During the supper meal on 4/18/2019, the Certified Nursing Assistant (CNA) that delivered RI #58's dinner meal tray did not thoroughly read the tray ticket, to ensure the correct diet was given to the resident. [...]

Inspectors wroteBased on interviews, review of Resident Identifier (RI) #58's medical record, facilities' policies titled Death of a Resident, Documenting, Charting and Documentation, Vital Signs, an unlabled facility document, and a complaint received by the Alabama State Survey Agency, the facility's licensed nursing staff failed to document in RI #58's medical record an accurate description of the events surrounding the resident being found deceased in the facility on 4/18/2019. The licensed staff further failed to document in RI #58's medical record, a complete assessment of the resident, to include vital signs, the findings from the assessment, the time of pronouncement and the name of the individual who pronounced RI #58 deceased to ensure RI #58's medical record validated the accuracy of the resident's death in the facility. [...]

Inspectors wroteBased on observation, interviews, and the facility's policy titled Standard Precautions Infection Control, the facility failed to ensure Employee Identifier (EI) #15, a laundry aide, washed her hands after touching a door knob in the soiled utility room, walked into the clean utility room, and began folding linen without washing her hands, and did not touch her upper area of her uniform top, prior to folding clean F Hall resident's linen. This had the potential to affect one of seven halls, the F Hall where 34 of 157 residents in the facility reside.

Inspectors wroteBased on observation, interviews, and the facility's policy titled Required Training, Certification and Continuing Education of Nurse Aides, the facility failed to ensure Employee Identifier (EI) #17, a Certified Nursing Assistant (CNA) received Continuing Education Units (CEUs) on Dementia Training from the period of 4/4/2018 to 4/4/2019. This affected one of five CNAs reviewed for Dementia Training.

Inspectors wroteBased on observation, interviews and review of facility policies titled, Use of Leftovers and Nourishments and Supplements and the 2017 FOOD CODE, the facility failed to ensure: 1) refrigerated left-over foods were consistently labeled with a use-by date (UBD) in both the Dietary Department and on the Nursing Stations or were discarded by that UBD; 2) sour cream was covered to prevent exposure to contaminants during storage; 3) the dish washer maintained adequate wash temperatures and chlorine concentrations for dish sanitization; 4) potentially hazardous food was stored at a recommended temperature of 41 degrees Fahrenheit (F) or below; and 5) the return vent over the tray line was free of an accumulation of dust tags. This had the potential to affect all 147 residents for whom meals were prepared and served at the time of this survey.

Inspectors wroteBased on observations, interviews, medical record review, and a review of the facility's policy titled, Standard Precautions Infection Control the facility failed to ensure staff washed their hands prior to applying gloves and after removing gloves during medication administration for Resident Identifier (RI) #100, RI #104 and RI #109. This affected three of five residents observed during medication pass observation. Findings Include: A review of the facility's policy titled, Standard Precautions Infection Control dated 11/27/16, revealed the following: .1. Hand Hygiene: a. During delivery of patient care services, avoid unnecessary touching of surfaces in close proximity to the patient to prevent both contamination of clean hands from environmental surfaces and transmission of pathogens from contaminated hands to surfaces . e. Perform hand hygiene: i. [...]

Inspectors wroteBased on record review, interview and a review of the facility policies titled, Notification of Change in Condition/Statusand Change of Room or Roommate, the facility failed to ensure RI (Resident Identifier) #251's sponsor was notified of the resident's room change. This affected RI #251, one sampled resident observed for notification of change.

Inspectors wroteBased on interviews, medical record review, review of a facility policy titled, Abuse, Neglect and Exploitation and review of a facility document titled, Resident Incident Report, the facility failed to ensure Resident Identifier (RI) #45 was free from abuse on 05/24/18, during a resident to resident altercation with RI #12. This affected RI #45 and RI #12, two of 44 sampled residents. Findings Include: A review of a facility policy titled, Abuse, Neglect and Exploitation dated 11/27/16, revealed the following: Policy: Each resident has the right to be free from abuse, .Residents must not be subject to abuse by anyone, including, but not limited to; facility staff, other residents, .Policy Explanation and Definitions: .1. Abuse means the willful infliction of injury . intimidation .with resulting physical harm, pain or mental anguish.3. [...]

Inspectors wroteBased on interviews, medical record review, review of a facility policy titled, Abuse, Neglect and Exploitation, review of a facility document titled, Resident Incident Report and review of a document titled, Alabama Department of Public Health Online Incident Reporting System, the facility failed to report a resident to resident altercation between Resident Identifier (RI) #12 and RI #45 to the State Agency within a two hour time frame, when it occurred on 05/24/18. This affected RI #12 and RI #45, two of 44 sampled residents. Findings Include: A review of a facility policy titled, Abuse, Neglect and Exploitation dated 11/27/16, documented: .13. In response to allegations of abuse .the facility must: a. [...]

Inspectors wroteBased on interview and record review, the facility failed to develop a plan of care for RI (Resident Identifier) #48's hearing deficit. This affected Resident Identifier (RI) #48, one of 44 sampled residents whose care plans were reviewed.

Inspectors wroteBased on interview, medical record review and a review of the facility's job description titled, CERTIFIED NURSING ASSISTANT, the facility failed to ensure staff provided incontinent care for Resident Identifier (RI) #147 when he/she requested to be changed after an incontinent episode. This affected one of one resident who complained of not receiving care after having an incontinent episode. Findings Include: A review of the facility's job description titled, CERTIFIED NURSING ASSISTANT without a date, revealed the following: .GENERAL PURPOSE Perform direct resident care duties in accordance with the resident's assessment and care-plan . ESSENTIAL JOB FUNCTIONS General Skills .Ensure residents are clean and comfortable . RI #147 was re-admitted to the facility on [DATE], with diagnoses to include Chest pain and Acquired Absence of Left Leg Below the Knee. [...]

Inspectors wroteBased on observation, interview, medical record review and review of the facility's policy titled, (Name of Facility-Administering Medications through an Enteral Tube, the facility failed to ensure licensed staff flushed Resident Identifier (RI) #104's Gastrostomy Tube (GT) with the recommended amount of water in between medications during medication administration. This affected one of one resident observed with a GT during medication administration. Findings Include: A review of the facility's policy titled, (Name of Facility)-Administering Medications through an Enteral Tube with a revised date of April 2018 revealed: .25. If administering more than one medication, flush with 15 ml (milliliter) .water between medications . RI #104 was admitted to the facility on [DATE], with diagnoses to include Acute Respiratory Failure and Gastrostomy Status. [...]

Inspectors wroteBased on observation, interviews, medical record review, and a review of the facility's policy titled, Administering Medications , the facility failed to ensure the medication error rate was less than 5%. There were a total of 25 opportunities with two errors, which yielded a medication error rate of 8%. This affected RI #100 and RI #104, two of five residents observed during medication administration. Findings Include: A review of the facility's policy titled, Administering Medications, with a revised date of April 2010, revealed the following: .9. Medications .must be administered within one (1) hour of their prescribed time . 1. RI #100 was re-admitted to the facility on [DATE], with diagnoses to include Atherosclerosis and Hypothyroidism. A review of RI #100's August Physician's Orders revealed: [...]