Blossom Healthcare & Rehabilitation Center

Inspectors wroteBased on observation, staff interviews, and review of the facility policy titled Dating & Expired Food Items Policy, the facility failed to ensure that food items were dated when opened. In addition, the facility failed to ensure that food items were not stored or made available for use beyond their expiration dates. The deficient practices had the potential to place the 81 residents who received food and hydration from the kitchen at increased risk of foodborne illness.

Inspectors wroteBased on observations, staff interviews, and review of the facility's policies titled Medication Storage in the Healthcare Centers and Medication Administration: General Guidelines, and Medication Administration: General Guidelines, the facility failed to ensure one of three medication carts and one of one wound care cart were locked and secured when out of the direct sight of the nurse. In addition, the facility failed to discard expired medical supplies in one of four supply rooms. Additionally, the facility failed to ensure that medications on two of three medication carts were stored in a sanitary manner. These deficient practices have the potential to place residents residing in the facility at risk of unauthorized access to medications, use of expired medical supplies, and avoidable infection related to cross-contamination. The census was 80 residents.

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility policy titled Medication Administration: General Guidelines, the facility failed to ensure three of 34 sampled residents (R) (R61, R19, and R43) were assessed for medication self-administration before allowing medications at the bedside. This deficient practice has the potential to place R61, R19, and R43 at risk of unsafe medication use and not receiving medication according to the prescriber's order.

Inspectors wroteBased on record review, staff interviews, and review of the facility's policy titled Abuse, Neglect, Exploitation or Misappropriation-Reporting and investigation, the facility failed to report an allegation of verbal/mental abuse to the State Survey Agency (SSA) for two of 34 sampled residents (R) (R20 and R46). This deficient practice had the potential to place residents at increased risk of abuse.

Inspectors wroteBased on staff and resident interviews, record review, and review of the facility's policy titled Abuse, Neglect, Exploitation or Misappropriation-Reporting and Investigating, the facility failed to ensure that allegations of verbal and physical abuse were thoroughly investigated for two of 34 sampled residents (R) (R20 and R46). This deficient practice had the potential to place the residents at increased risk of abuse.

Inspectors wroteBased on observation, staff interviews, record review, and review of the facility's policy titled [facility name] Care Plans Policy, the facility failed to develop or implement a comprehensive person-centered care plan for four of 34 sampled residents (R) (R21, R46, R76, and R4). This deficient practice had the potential to place R21, R46, R76, and R4 at risk of unmet needs, medical complications, and diminished quality of life.

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility document titled PICC Lines Procedures, the facility failed to ensure one of one resident (R) (R87) with a peripheral inserted central catheter (PICC) [a long, thin tube inserted into a small arm vein, threaded to a large vein near the heart] from a total sample of 34 residents received care in accordance with professional standards. This deficient practice had the potential to place R87 at increased risk of medical complications.

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility's policy titled Oxygen Therapy Policy, the facility failed to ensure four of 29 residents (R) (R43, R46, R76, and R4) with oxygen orders received oxygen as ordered by the physician. This deficient practice has the potential to place residents R43, R46, R76, and R4 at increased risk of respiratory complications.

Inspectors wroteBased on observations, resident and staff interviews, review of the facility's policy titled Side Rail Usage Policy, and review of the facility's protocol titled Restraint- Least Restrictive, the facility failed to ensure that one of 34 sampled residents (R) (R 21) was free from bedrail restraint. This deficient practice had the potential to place R21 at risk of medical complications and a decreased quality of life.

Inspectors wroteBased on observations, staff interviews, record reviews, and review of the facility's policy titled Soiled Laundry and Bedding Policy, the facility failed to ensure that laundry staff followed infection control processes while performing laundry services. In addition, the facility failed to ensure infection control measures were followed for one of 16 sampled residents (R) (R76) receiving oxygen. These deficient practices had the potential to place residents at risk for infections due to contamination. The census was 80 residents.

Inspectors wroteBased on interviews and a review of the In-Service Deficiency Report, the facility failed to ensure an effective training program for all new and existing staff was implemented and maintained. The failure to ensure an effective training program was in place had the potential to impact all of the residents in the facility related to safety, person-centered environment, and the number of adverse events or other resident complications.

Inspectors wroteBased on interviews and observation, the facility failed to ensure three residents (R) (R52, R6, and R285) of 30 sampled residents had enough clean linen, specifically pillowcases, to ensure every resident had enough for all of their pillows. This had the potential for the residents not to have a home-like environment.

Inspectors wroteBased on interviews and record review, the facility failed to ensure two residents (R) (R24 and R78) and/or the resident representative (RR) of five residents reviewed for unnecessary medications out of a total sample of 30 residents was informed of the risk and benefits of physician ordered antipsychotic medications. This failure placed the resident and/or representative at risk of not knowing the risks and benefits of the use of medications.

Inspectors wroteBased on interviews and record review, the facility failed to provide one of three residents (R) (R134) reviewed for Notice of Medicare Non-Coverage (NOMNC) of 30 sampled residents, a NOMNC 48 hours before the end of a Medicare-covered Part A stay. This had the potential for the resident to not have the opportunity to appeal the decision to end the Medicare Part A stay.

Inspectors wroteBased on observations, staff interviews, and a review of the facility's policies titled Food Storage and Procurement, and Diet/Food Handling, the facility failed to ensure that food items in the two refrigerators and two freezers were properly labeled, dated, and securely wrap opened food items and discarded foods when expired; failed to properly use the three-compartment sink to properly sanitize dishware. Additionally, the facility failed to thaw frozen meat and fish properly to prevent bacterial growth; failed to store stacked pans free from wet nesting to prevent bacterial growth; failed to have soap in the soap dispenser and paper towels in the towel dispenser so staff could properly wash and dry hands; failed to clean the can opener and free from debris buildup to prevent cross contamination; and failed to maintain a clean and sanitary kitchen. [...]

Inspectors wrote4. Observations on 7/14/2023 at 10:00 a.m. and 4:20 p.m., 7/15/2023 at 7:58 a.m., and 7/16/2023 at 10:00 a.m. of room [ROOM NUMBER] revealed a loose night light fixture cover on the wall near resident in 309A. Observation and interview on 7/16/2023 at 10:00 a.m. with Administrator and Maintenance Supervisor verified the loose light fixture cover on the wall. The Maintenance Supervisor has fixed the night light cover in the past. He indicated it gets caught on the bed when they lower it, and the bed is kept against the wall. He indicated he was not aware of the problem. They usually use verbal communication or electronic communication on an app to report problems. He checks the electronic report daily. 3. Observations on 7/14/2023 at 10:00 a.m. and 4:20 p.m., 7/15/2023 at 7:58 a.m. and 7/16/23 at 10:00 a.m. [...]

Inspectors wroteBased on observation, staff interviews, and record review, the facility failed to ensure that dietary staff followed recipes for preparing pureed foods to avoid compromising the nutritive value, flavor, or appearance. This affected six of 83 residents receiving an oral diet.

Inspectors wrote2. Review of the policy titled Laundry Dyer Vent Cleaning policy dated 1/15/2023 revealed: Environmental staff-laundry staff will check and clean out the dryer vent after each load. Laundry staff will notify maintenance if there are other areas that need cleaning or minor maintenance. Review of the Tumble Dryers __ Operation Maintenance manual for dryer number one. Safety Information: This tumble dryer must not be activated without lint screen filter. When you perceive a gas odor, immediately shut off the gas supply and ventilate the room. Do not power on electrical appliances and do not pull electrical switches. Do not use matches or lighters. Do not use a phone in the building. Warn the installer, and if so desired, the gas company, as soon as possible. To avoid fire and explosion, keep surrounding areas free of flammable and combustible products. [...]

Inspectors wroteBased on observation, staff and resident interview, record review, and review of the facility's policy titled Foley Catheter Care, the facility failed to maintain dignity by ensuring a dignity bag was provided for one of six residents (R) (R#16) who had an indwelling urinary catheter. This failure had the potential to diminish the resident's quality of life in an environment that promotes the maintenance or enhancement of each resident's quality of life.

Inspectors wroteBased on observations and staff interviews, the facility failed to ensure a reasonable accommodation of need by keeping the call within reach of residents when in their room to call for staff assistance for three of sixteen Residents (R) (#41, #4, #14) in the 300 Hall. Observations on 7/14/2023 at 11:28 a.m. and 4:25 p.m., 7/15/2023 at 7:45 a.m., and 7/16/2023 at 10:00 a.m. of room [ROOM NUMBER]A R#4 and 311B R#14 revealed call lights for both bed A and B were wrapped around the call box and not in reach of the resident. Both residents were sitting up in a chair beside the bed during observations or in the bed. Observations on 7/14/2023 at 11:36 a.m. and 4:35 p.m., 7/15/2023 at 7:55 a.m., and 7/16/2023 at 10:00 a.m. of room [ROOM NUMBER]B R#41 revealed call light for bed B was on the floor and not in reach of the resident. The resident was asleep in bed during observations. [...]

Inspectors wrote3. Review of the most recent Significant Change Minimum Data Set (MDS) for R#27 dated [DATE] revealed Section C-Cognition: Brief Interview of Mental Status (BIMS) score of 13, indicating minimum cognitive deficit. Record review of the care plan R#27 revealed: No care plan in place related to advanced directives. The resident has a terminal prognosis and is on Hospice services dated [DATE]. Record review of Physician orders for R#27 revealed no order or indication on the Electronic Medical Record (EMR) documenting the resident's advanced directive wishes. Record review of the EMR revealed an Advanced Directive Checklist-Georgia that indicates R#27 has executed an advanced directive as indicated below and will provide copy to the facility, dated, and signed by responsible party [DATE]. [...]

Inspectors wrote2. Record review of the most rececent Significant Change Minimum Data Set (MDS) for R#27 dated 5/22/2023 revealed Section C-Cognition: Brief Interview of Mental Status (BIMS) score of 13, indicating minimum cognitive deficit. Record review of the care plan for R#27 revealed: No care plan in place related to advanced directives. Record review of the medical record revealed an Advanced Directive Checklist-Georgia that indicates R#27 has executed an advanced directive as indicated below and will provide copy to the facility, dated, and signed by Responsible Party (RP) 1/3/2022. A review of R#27's Hospice binder revealed a document titled Authorization for Allow of Natural Death dated and signed by her RP 5/12/2023 and Physician indicated resident wishes to be a Do Not Resuscitate (DNR). Interview on 7/15/2023 at 2:18 p.m. [...]

Inspectors wroteBased on staff interviews, record review, and review of the facility policy titled, Fountain Blue Rehab and Nursing Bed Hold Policy, the facility failed to ensure one of 16 Residents (R) (#382) that was discharged in the last 30 days received notification of the facility bed hold policy upon transfer to the Acute Hospital; reviewed for bed hold policy.