Azalea Gardens Nursing Center

Inspectors wroteBased on observation, staff interview, and facility policy review, the facility failed to use hand hygiene, discard overly ripe produce, and failed to calibrate a food thermometer prior to checking food temperatures, for two (2) of two (2) kitchen observations.

Inspectors wroteBased on observation, staff interview, record review, and facility policy review, the facility failed to ensure a nurse performed hand hygiene, changed gloves, and discarded a feeding tube syringe after it was dropped onto the floor during a medication administration observation for one (1) of three (3) residents reviewed for medication administration. (Resident #31)

Inspectors wroteBased on observation, staff interview, record review, and facility policy review, the facility failed to post the daily nursing staffing hours in a location readily accessible to residents and visitors and failed to update the posted staffing for three (3) of four (4) days of survey. This deficient practice had the potential to affect all 63 residents residing in the facility.

Inspectors wroteBased on observations, interviews, record review, and facility policy review, the facility failed to identify physical restraints related to the use of full-length bed rails and a lap buddy (type of chair restraint) for ten (10) of 19 sampled residents. Resident #1, Resident #10, Resident #13, Resident #19, Resident #41, Resident #45, Resident #54, Resident #58, Resident #60, and Resident #61. Findings Include: A record review of the facility's policy Physical Restraint Application Policy, dated January 2018, revealed Policy: The purpose of this procedure is to provide safety or postural support of a resident to prevent injury to the resident or others when the resident has medical symptoms that warrant the use of restraints . [...]

Inspectors wroteBased on record review, staff interview, and facility policy review, the facility failed to develop a care plan for physical restraints related to the use of full length bed rails and a lap buddy (a form of chair restraint) for 10 of 19 residents sampled. Resident #1, Resident #10, Resident #13, Resident #19, Resident #41, Resident #45, Resident #54, Resident #58, Resident #60, and Resident #61.

Inspectors wroteBased on record review, facility policy review, and interviews, the facility failed to comply with Resident #74's right to refuse or accept treatment regarding her wishes for no Cardiopulmonary Resuscitation (CPR) in the event if her heart stops beating or she stops breathing, no other medical treatment would be started or continued. Resident #74 had an elective Advanced Directive for a Do Not Resuscitate (DNR) code status and a Physician's Order for a DNR, dated [DATE]. On [DATE], the facility staff did not verify Resident #74's code status, before initiating Cardiopulmonary Resuscitation (CPR) when staff discovered the resident unresponsive with no evidence of a pulse or respirations. An Immediate Jeopardy (IJ) was determined to exist, on [DATE] at 7:28 PM, when facility staff found Resident #74 unresponsive, without a pulse or respirations. [...]

Inspectors wroteBased on staff interview, record review and facility policy review, the facility failed to ensure Resident #74's Care Plan was implemented for a Do Not Resuscitate (DNR) code status, and to develop/implement Resident #22's Care Plan for pain medication administration as needed during wound care. These concerns were identified for two (2) of 30 care plans reviewed. Resident #74 had a Care Plan initiated and revised, on [DATE], for a DNR code status. The SA identified an Immediate Jeopardy (IJ) on [DATE] at 7:28 PM, when Resident #74 was found unresponsive and without a pulse or respirations by the facility staff. The facility staff failed to verify Resident #74's code status. Cardiopulmonary Resuscitation (CPR) was initiated by the facility staff until the local Fire Department arrived at 7:35 PM, and reviewed Resident #74's chart where the DNR code status was documented. [...]

Inspectors wroteBased on interviews, record review and facility policy review, the facility failed to honor Resident #74's Do Not Resuscitate (DNR) code status by initiating Cardio-Pulmonary Resuscitation (CPR) when the resident was found by the facility staff unresponsive and with no pulse or respirations, for one (1) of four (4) residents reviewed who had expired in the facility within the past six (6) months. The State Agency identified an Immediate Jeopardy (IJ) and Substandard Quality of Care (SQC) on [DATE]. Resident #74 had a Physician's Order and Advance Directive for a Do Not Resuscitate (DNR) code status dated [DATE] and was found by staff, on [DATE] at 7:28 PM, without a pulse or respirations. CPR was initiated by the facility's staff for five (5) minutes until the local Fire Department arrived. [...]

Inspectors wroteBased on interviews, record review and facility policy review, the facility failed to ensure Resident #74's choice for a Do Not Resuscitate (DNR) code status was honored. This was identified for one of four (1 of 4) residents reviewed who expired in the facility over the past six (6) months. The State Agency (SA) identified an Immediate Jeopardy (IJ) and Substandard Quality of Care (SQC) on [DATE]. Resident #74 had a Physician's Order and an Advanced Directive, dated [DATE], for a DNR code status. On [DATE] at 7:38 PM, Resident #74 was found unresponsive, and without a pulse or respirations by the facility's staff. Cardiopulmonary Resuscitation (CPR) was initiated by the facility's staff and the Emergency Medical System (EMS) was notified. The local Fire Department was dispatched to the facility. [...]

Inspectors wroteBased on interviews, record review, and facility policy review, the facility failed to monitor, review, and evaluate their Quality Assessment and Assurance (QAA) plan to identify and document the resident's Advance Directive choice for code status. During the initial recertification survey on [DATE] to [DATE], the State Agency (SA) identified the facility's failure to honor Resident #74's Do No Resuscitate (DNR) code status, on [DATE], when the resident was found unresponsive, and without a pulse and respirations. The facility staff initiated Cardiopulmonary Resuscitation (CPR), which continued for five (5) minutes until the Fire Department arrived and reviewed the resident's medical record which revealed the DNR code status. Resident #74 was never revived and announced deceased at the facility. [...]

Inspectors wroteBased on observation, interviews, record review and facility policy review, the facility failed to assess or administer pain medication for Resident #22's gestures and verbalization of pain/comfort during wound care. Resident #22's wound care was observed, 11/26/2019 at 9:00 AM. Resident #22 exhibited gestures and verbalization of pain, such a pulling her left leg up and saying Owww twice during the treatment. The wound was located on the left heel. Resident #22 was not assessed by the Treatment Nurse neither time, and therefore no pain medication was offered or administered. Resident #22 had orders for a pain medication every (6) six hours as needed. As a result, the nurse's failure to assess and administer Resident #22's pain medication during the wound care observation, raised this concern to a harm level. [...]

Inspectors wroteBased on observations, interviews, record review, and facility policy review, the facility failed to assist three (3) of six (6) residents, who attended the Resident Group Interview meeting, on 11/25/2019, to participate in the Gubernatorial election on 11/6/2019. The residents who voiced their concern regarding their voting rights were Resident #20, Resident #44 and Resident #54.