Autumn Care of Waynesville

Inspectors wroteBased on observation and staff interviews, the facility failed to discard food past its use-by date in 1 of 1 walk-in cooler. This practice had the potential to affect food served to residents.

Inspectors wroteBased on record review and staff interviews, the facility failed to develop a person-centered individualized care plan for 1 of 3 residents reviewed for urinary catheters (Resident #6).

Inspectors wroteBased on observations, record review, resident, staff, and Physician Assistant (PA) interviews, the facility failed to follow a physician order to float Resident #47's heels while in bed as tolerated during three observations. Additionally, the facility failed to implement a bowel protocol for Resident #43 who had not had a bowel movement documented in 6 days. This deficient practice occurred for 2 of 4 residents (Resident #47 and Resident #43) reviewed for quality of care.

Inspectors wroteBased on record review, observation and interviews with the resident, staff and the Hospice Nurse, the facility failed to provide a physician's order and an indication for use of an indwelling catheter for 1 of 3 residents reviewed for urinary catheters (Resident #6).

Inspectors wroteBased on observation and staff interviews, the facility failed to ensure [NAME] Wing Medication Cart #1 was secured while unattended for 1 of 4 medication carts observed for medication storage (West Wing Medication Cart #1).

Inspectors wroteBased on observation and staff interviews, the facility failed to follow their infection control policies and procedures for clean dressing change and hand hygiene when Wound Nurse Aide (NA) #1 failed to change her gloves and perform hand hygiene while performing wound care for Resident #5. This deficient practice occurred for 1 of 5 staff members observed for infection control practices (Wound NA #1).

Inspectors wroteBased on observations, record review, and staff interviews, the facility failed to implement their policy for Enhanced Barrier Precautions (EBP) for a resident (Resident #3) when Nurse #1 performed wound care without donning a gown. The deficient practice occurred for 1 of 1 staff member (Nurse #1) observed for infection control practices during wound care.

Inspectors wroteBased on record review, staff, and Adult Protective Services (APS) Social Worker (SW) interviews, the facility failed to follow and implement their abuse policy and procedures in the areas of protecting, investigating, and reporting to the Administrator, the State Agency, and/or law enforcement for 2 of 4 residents (Resident #51 and Resident #65) reviewed for abuse. Nursing Assistant (NA) #1 observed NA #2 strike Resident #65 with an open hand during care and did not immediately intervene, did not report the incident immediately to the Administrator, and NA #2 continued to work on the floor with other residents. This failure resulted in a lack of protection for other residents.

Inspectors wroteBased on record review, and staff and family interviews, the facility failed to determine if a resident with cognitive impairment had a Resident Representative before allowing the resident to sign admission paperwork for 1 of 1 resident (Resident #91) reviewed for resident rights.

Inspectors wroteBased on record review and staff interviews, the facility failed to protect a severely cognitively impaired resident (Resident #65) from the right to be free of physical abuse. On 3/07/27 around 10:30 PM, when Nursing Assistant (NA) #1, and NA #2 were providing care for Resident #65, the resident became agitated and combative. NA #2 struck the resident with an open hand on her lower left arm. The deficient practice occurred for 1 of 4 residents reviewed for abuse.

Inspectors wroteBased on record reviews and staff interviews, the facility failed to ensure an as needed (PRN) psychotropic medication, Lorazepam, prescribed for anxiety/restlessness had a stop date of 14 days for 1 or 6 residents (Resident #80) reviewed for unnecessary medications.

Inspectors wroteBased on observation and staff interviews, the facility failed to remove four containers of fortified nutritional shake nectar consistency that had a used by date of 1/27/25. The four expired containers were found in 1 of 2 nourishment rooms. These practices had the potential to affect any residents that used nectar thickened consistency.

Inspectors wroteBased on record review and interviews with resident and staff, the facility failed to remove used lidocaine and clonidine patches as specified by the physician for 2 of 3 residents reviewed for unnecessary medications (Resident #1 and Resident #2).

Inspectors wrote3. Resident #18 was admitted to the facility on [DATE] with diagnoses that included type 2 diabetes mellitus, coronary artery disease, and hypertension. Physician records and active physician orders revealed she also had a diagnosis of edema (swelling in the extremities). The admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #18 was cognitively intact and coded as receiving diuretic medication (a medication that helps remove excess fluid from the body). Review of Resident #18's active physician orders revealed an order dated [DATE] for Furosemide (diuretic) tablet 40 milligrams (mg) give one tablet by mouth two times a day for edema. Review of Resident #18's electronic medication record (EMR) was completed on [DATE] and revealed Resident #18's weight had been monitored monthly by the facility. [...]

Inspectors wroteBased on record review, facility staff and Medical Director (MD) interviews, the facility failed to ensure that facility staff (Nurse #1 and Paramedic #1) had completed Skills Competency's and required floor/unit orientation days with a preceptor prior to taking a resident assignment independently. On [DATE] at 2:30 pm, Nurse #2 informed Nurse #1 that Resident #280 had been excessively sleepy during her shift. Nurse #1 failed to assess Resident #280 until 5:00 pm, at which time Resident #280 was only responsive to painful stimuli. Nurse #1 was instructed at 6:30 pm to transfer Resident #280 to the hospital for evaluation and treatment. Nurse #1 failed to notify Emergency Medical Services (EMS) and was under the assumption that the oncoming staff member, Paramedic #1 (employed by the facility and functioning as a nurse), was going to notify EMS. [...]

Inspectors wroteBased on record reviews, staff, and Medical Director (MD) interviews the facility failed to protect a Resident's right to be free from neglect when Resident # 280 experienced a medical emergency and emergency medical services (EMS) were not provided. The resident was only responsive to painful stimuli on [DATE] around 5:00 PM and 911 was not initiated until 8:10 PM. Resident #280 was transferred to the hospital and diagnosed with metabolic encephalopathy (a problem in the brain caused by a chemical imbalance) due to urinary tract infection (UTI) and possibly due to cellulitis/infected lower extremity wounds or hypoglycemia. On [DATE] Resident #280 was discharged to hospice care for comfort care. On [DATE] Resident #280 expired. This occurred for 1 of 3 residents reviewed for neglect. Immediate jeopardy began on [DATE] when EMS was not initiated for a medical emergency. [...]

Inspectors wroteBased on record review, family and staff interviews, the facility failed to prevent a pressure injury for a resident wearing a hinged knee brace. Resident #280 sustained an open pressure injury that became infected, had developed dead tissue, and wound treatments had not been completed. The deficient practice was identified for 1 of 2 residents (Resident #280) reviewed for pressure ulcers.

Inspectors wroteBased on record reviews, family member, staff, resident, and lift company representative interviews the facility failed to prevent injury when transferring a resident (Resident #280) from a wheelchair to the bed causing a laceration to the resident's left lower leg which required a transfer to the emergency department and treatment of the laceration with sutures. The facility failed to provide a safe transfer when they did not use a mechanical sit-to-stand lift in accordance with manufacturer instructions to transfer a resident (Resident #60). This deficient practice occurred for 2 of 3 residents (Resident #280 and Resident #60) reviewed for accidents and hazards.

Inspectors wroteBased on observations and staff interviews, the facility failed to maintain clean and sanitary kitchen conditions as evidence by debris present on the kitchen floor and in the tile grout, dried food particles on a utility cart that was used to store clean dishware, dried debris on the steam table hood, dried debris on the outside oven surfaces. The facility also failed to ensure ready for use metal pans, insulated dome plate covers, insulated plate under liners, and dishware were clean and not stacked wet. This occurred for 2 of 2 kitchen observations. These practices had the potential to affect food served to residents.

Inspectors wroteBased on record reviews, staff, resident, and lift company representative interviews the facility failed to accommodate the needs of a bariatric resident who needed a mechanical sit-to-stand lift with a larger knee brace for transfers for 1 of 1 resident (Resident #60) reviewed for accommodation of needs.

Inspectors wroteBased on record reviews and interviews with family members, resident, and staff, the facility failed to provide a resident with a written notice of a room change including the reason for the change for 1 of 1 resident reviewed for room change (Resident #230). The right to receive written notice, including the reason for the change, before the resident ' s room or roommate in the facility is changed.

Inspectors wroteBased on record review and staff interviews the facility failed to accurately document the resident's code status on the Medical Orders for Scope of Treatment (MOST) form. The facility also failed to provide Emergency Medical Services (EMS) a copy of a resident's advanced directive when she was transferred to the emergency room after being found unresponsive for 2 of 2 residents reviewed for advanced directives (Resident #12 and #280).

Inspectors wroteBased on record review, family, resident, staff, and provider interviews the facility failed to notify the emergency contacts when a resident (Resident #280) had a change in condition and was sent to the Emergency Room. Furthermore, the facility failed to notify the provider of significant weight gain for a resident (Resident #18) that required diuretic medication. This deficient practice occurred for 2 of 2 sampled residents reviewed for notification of change.

Inspectors wroteBased on record review and staff interviews the facility failed to implement their abuse policies and procedures by not submitting an Initial Allegation Report within two hours of being notified of Resident neglect on 4/30/2024 at 6:10 PM and the facility continued to place residents at risk for neglect as they allowed Nurse #1 and Paramedic #1 to continue working after being notified of the neglect, for 1 of 3 residents (Resident #280) reviewed for abuse. Additionally, staff failed to report an allegation of staff to resident abuse to administration immediately and the facility failed to notify law enforcement of the abuse allegation for 1 of 3 residents (Resident #39) reviewed for abuse.

Inspectors wroteBased on observations, record review, registered dietician, dialysis center, staff and physician interviews, the facility failed to maintain ongoing communication with the dialysis center, failed to assess a resident post dialysis, and failed to implement orders from the dialysis center for fluid restrictions and a renal diet for 1 of 1 resident reviewed for dialysis (Resident #19).

Inspectors wroteBased on observations, record review, staff, and Pharmacy Consultant interviews the facility failed to maintain a medication error rate of less than 5% by having 2 errors out of 25 opportunities which resulted in an 8% medication error rate. This affected 1 of 4 residents observed on medication pass (Resident #282).

Inspectors wroteBased on observations, record review, resident and staff interviews, the facility failed to secure medications found at the bedside for 1 of 1 resident reviewed for medication storage (Resident #53).

Inspectors wroteBased on observations, record review, staff and physician interviews the facility failed to initiate Enhanced Barrier Precautions (EBP) for a resident with an indwelling vascular access device. This deficit practice occurred for 1 of 1 resident (Resident # 19) reviewed for indwelling medical devices.

Inspectors wroteBased on record review, Resident, former staff, Corporate Human Resources Representative and current staff interviews, the Governing Body or its designated person failed to have the Business Office Manager sign a Duty to Disclose Conflict of Interest form and approve or deny a plan to purchase property from a resident for 1 of 1 resident (Resident #8) reviewed for compliance and ethics policy implementation.

Inspectors wroteBased on observations, resident and staff interviews, the facility failed to display survey results in a location accessible to residents during 5 of 5 observations of the facility.

Inspectors wroteBased on record review, Resident Representative, Ombudsman and staff interviews, the facility failed to provide a written notice of transfer/discharge to the Resident and Resident Representative and failed to send a copy of the notice to the local Ombudsman for 1 of 2 residents (Resident #280) reviewed for discharge.