Coosa Valley Health and Rehab

Inspectors wroteBased on observations, record review, interviews, and review of a facility policy titled Perineal Care, the facility failed to provide incontinence care to RI (Resident Identifier) #43 in a timely manner. This deficient practice had the potential to affect RI #43, one of one resident sampled for incontinence care.

Inspectors wroteBased on observations, record review, and interviews, the facility failed to ensure Resident Identifier (RI) #31, had documented medical justification for the use of an indwelling urinary catheter. This deficient practice affected RI #31; one of seven residents reviewed for catheter use.

Inspectors wroteBased on observation, interview and review of the Food Code United States Public Health Service facility failed to ensure: 1) ice cream cups in the walk-in freezer were frozen solid, 2) opened items in the walk-in freezer were properly resealed, 3) walk-in freezer was maintained at a temperature to ensure food items were frozen solid, and 4) a dietary aide did not continue to serve trays after dropping the handle of the thermometer into the gravy. This deficient practice had the potential to affect 86 residents receiving meals from the kitchen. Findings Include: The Food Code U.S. Public Health Service 2017 indicates the following: . Temperature and Time Control 3-501.11 Frozen Food. Stored froze Foods shall be maintained frozen. . 3-202.15 Package Integrity. Food packages shall . [...]

Inspectors wroteBased on observations, interviews and review of a facility policy titled, Resident Rights and a facility document titled, Maintenance Supervisor Job Description, the facility failed to ensure Room Locators (RL)'s #1-63 were free of chipped paint on walls and doors, missing tiles on floors, missing curtains on closets, equipment in disrepair and worn furniture. This was observed three of three days of the survey and affected 63 of 66 rooms on four of four halls of the facility. Findings Include: A review of a facility policy titled, Resident Rights, no date, page 5, revealed: . 9. Safe environment. The resident has a right to a safe, clean, comfortable and homelike environment, . A review of a facility document titled, Maintenance Supervisor Job Description, no date, revealed: . Ensure the building(s), equipment and utilities are maintained in good working order . [...]

Inspectors wroteBased on interview, medical record review and review of Centers for Medicare and Medicaid Services (CMS) Resident Assessment Instrument (RAI) Version 3.0 Manual, the facility failed to ensure Resident Identifier (RI) #65's Minimum Data Set (MDS) assessments did not have Gabapentin, an anticonvulsant medication, coded as an antipsychotic, which resulted in the assessments being inaccurate for use of antipsychotic medication. This deficient practice affected RI #65, one of 24 sampled residents whose MDS assessments were reviewed. Findings Include: A review of CMS's RAI Version 3.0 Manual, Chapter 3: MDS Items (N), Page N-6, documented: . Coding Tips and Special Populations * Code medications in Item N0410 according to the medication's therapeutic category and/or pharmacological classification, not how it is used. Resident #65 was admitted to the facility on [DATE]. [...]

Inspectors wroteBased on interview and medical record review, the facility failed to ensure Resident Identifier (RI) #87's care plan regarding code status was revised to reflect RI# 87's DNR (Do Not Resuscitate) decision. This affected RI # 87, one of twenty-four residents whose care plans were reviewed for code status. Findings Include: RI# 87 was admitted to the facility on [DATE] with diagnoses including, Cirrhosis of Liver, Ascites and Vascular Dementia. On 06/13/19 at 01:30 PM, a review of RI #87's medical record revealed a DNR order was written on 05/28/2019, along with an Advance Directive depicting the family's wishes of DNR. Further review revealed a Full Code Care Plan initiated on 04/22/2019 and reviewed by the facility on 05/27/2019, RI #87's Facesheet also depicted Full Code and did not reflect RI #87's decision for DNR. [...]

Inspectors wroteBased on observation, medical record review, interviews, and review of a facility polity titled Enteral Nutrition, the facility failed to ensure Resident Identifier (RI) #9's tube feeding was infusing at 60 ml (milliters) /(an) hr (hour) and tube feeding water flush was infusing at 25 ml (milliliters) /(an) hr( hour) as ordered by the physician. This was observed on 6/12/2019 and affected one of six resident sampled to receive tube feeding and feeding tube water flush. Findings Include: A review of a facility policy titled, Enteral Nutrition, with a revised date of 11/2018, revealed, .Policy Interpretation and Implementation . 11. The nurse confirms .orders for . e. Volume and rate of administration; . RI # 9 was readmitted to the facility on [DATE]. [...]

Inspectors wroteBased on interviews, medical record review and review of [NAME] and [NAME] Fundamentals of Nursing Ninth Edition, Chapter 23 Legal Implications in Nursing Practice, the facility failed to ensure a physician's order was accurately transcribed for Resident Identifier (RI) #87's code status. This affected RI #87, one of 24 sampled residents for whom medical records were reviewed. Findings Include: Review of [NAME] and [NAME] Fundamentals of Nursing Ninth Edition, Chapter 23 Legal Implications in Nursing Practice, copyright 2017, page 311, revealed the following: . Health Care Providers' Orders . Make sure that all health care provider orders are in writing . and transcribed correctly . RI #87 was admitted to the facility on [DATE]. The resident's diagnoses included Cirrhosis of Liver, Ascites and Vascular Dementia. [...]

Inspectors wroteBased on observations, interviews and review of facility policies titled, Standard Precautions and Instillation of Eye Drops, the facility failed to ensure: 1. a Licensed Practical Nurse (LPN) did not place inhaler mouthpieces on an unclean surface prior to putting them on RI #28's inhalers before storing them in the medication cart, and 2. an LPN did not wear the same gloves she wore while administering RI #1's crushed medication with an ice cream spoon and then administer RI #1's eye drops. These deficient practices affected RI #1 and RI #28, two of four residents and two of four nurses observed during medication pass observations. Findings Include: A review of a facility policy titled, Standard Precautions, Revised October 2018, documented: Standard precautions include the following practices: . 5. Resident-Care Equipment soiled . are handled in a manner that prevents . [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure residents were provided with knowledge of what an Advance Directive was and provide proof of whether they wanted to formulate one or not. This deficient practice affected Resident Identifiers (RI) #'s 11, 22,33, 36, 41, 45, 46, 50, 55, 57, 60, 62, 67, 68, 73, 76, 77 and 83, 18 of 22 sampled residents reviewed for implementation of Advance Directives.

Inspectors wroteBased on observation, interview, medical record review, and a review of the facility's policy titled, Administering Medications, the facility failed to ensure Resident Identifier (RI) #44 did not self administer a nebulizer treatment after being assessed as not having the ability to self administer medication. The affected one of one resident observed administering a nebulizer treatment. Findings Include: A review of the facility's policy titled, Administering Medications dated December 2012, revealed the following: Medications shall be administered in a safe . manner, and as prescribed. Policy Interpretation and Implementation 24. Residents may self-administer their own medications only if the Attending Physician, in conjunction with the Interdisciplinary Care Planning Team, has determined that they have the decision - making capacity to do so safely. [...]

Inspectors wroteBased on interview, record review and a facility policy titled, .Quality of Life-Accommodation of Needs, the facility failed to ensure Resident Identifier (RI) # 22 was given a choice for method of bathing. This affected one of one sampled resident who expressed a concern regarding baths.

Inspectors wroteBased on observation, interview and record review, and a facility's policy titled, . - Confidentiality of Information and Personal Privacy, the facility failed to ensure Resident Identifier (RI) #88's MAR (Medication Administration Record) was not left open to public view. This affected (RI) #88, one of three residents observed during medication administration. Findings Include: The facility's policy titled, . - Confidentiality of Information and Personal Privacy with a revised date of October 2017, revealed the following information: Policy Statement Our facility will protect and safeguard resident confidentiality and personal privacy. The Policy Interpretation and Implementation revealed, 2. The facility will strive to protect the resident's privacy regarding his or her: .b. medical treatment . 4. Access to resident personal and medical records will be limited to authorized staff . [...]

Inspectors wroteBased on observation, interview, record review and the facility policy titled, . Care Plan, Comprehensive Person - Centered, the facility failed to ensure staff consistently followed Resident Identifier (RI) #85's care plan for self care deficit with eating by not providing a weighted spoon during the breakfast and lunch meal on 07/24/18. This affected one of 23 sampled residents whose care plans were reviewed.

Inspectors wroteBased on observation, interview, medical record review, and a review [NAME] and Perry's FUNDAMENTALS OF NURSING, the facility failed to ensure staff followed Resident Identifier's (RI) #85's physician's order for a weighted spoon. This affected one of 23 sampled residents whose physician's orders were reviewed. Findings Include: A review of [NAME] and Perry's FUNDAMENTALS OF NURSING Ninth Edition, page 311 revealed the following: . Health Care Providers' Orders.follow health care providers' orders . Resident Identifier (RI) #85 was readmitted to the facility on [DATE]. Diagnoses included Autistic Disorder and Other Intellectual Disabilities. A review of RI #85's July 2018 Physician's Orders revealed an order for WEIGHTED SPOON WITH EACH MEAL. The order/start date was 01/12/18. On 07/24/18 at 8:13 AM, RI #85 was observed sitting up in bed for breakfast. [...]

Inspectors wroteBased on observation, interview, activity participation records, record review and the facility's policy titled, Activities Policies and Procedures Manual, the facility failed to provide Resident Identifier (RI) #55 with activities of choice from March 2018 to July 2018. The facility further failed to provide RI #73 with activities of choice on three of three days of the survey. This affected two of 23 sampled residents whose activity records were reviewed. Findings Include: The facility's policy titled, Activities Policies and Procedures Manual, with a revised date of October 29,2014 revealed: Procedure: . 2) The department will continuously offer residents a wide range of activities program opportunities so that they may explore any and all potential leisure interests. 5) The department will continue to invite residents to group programs, one-to-one activities contacts, . [...]

Inspectors wroteBased on observation, interview, record review and a review of the facility's policy titled, Administering Medications through an Enteral Tube, the facility failed to ensure a licensed staff member administered water flushes in a Gastrostomy Tube (GT) in between each medication administration. The facility further failed to ensure the licensed staff diluted each crushed medication with at least 15 cubic centimeters (cc) of water for administration to Resident Identifier (RI) #39. This affected one of one residents observed during medication administration via a GT. Findings Include: A review of the facility's policy titled, . Administering Medications through an Enteral Tube, revised April 2018, was conducted. The purpose of the policy was to provide guidelines for the safe administration of medications through an enteral tube. General Guidelines included the following, . 4. [...]

Inspectors wroteBased on interview, review of Record of Destruction forms and a review of the facility's policy titled, Discarding and Destroying Medications, the facility failed to ensure drug destruction records contained the method of destruction from February 2018 to May 2018. This affected four months of Record of Medication Destruction forms reviewed. Findings Include: A review of the facility's policy titled, Discarding and Destroying Medications with a revised date of October 2014, revealed the following: . Policy Interpretation and Implementation . 10. The medication disposition record will contain the following: f. Method of disposition; . A review of the facility's Record of Medication Destruction forms from February 2018 to May 2018, revealed no method of destruction was listed on the forms provided to the surveyor. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the medication error rate was less than 5%. There were a total of 26 opportunities observed during medication administration with five errors. The medication error rate was 19.23 %. This deficient practice affected RI (Resident Identifier) #39, one of four residents observed during medication administration.

Inspectors wroteBased on observation, interview, medical record review and a review of the facility policy titled, Accuracy and Quality of Tray Line Service, the facility failed to ensure Resident Identifier (RI) #83 and RI #67 received fried eggs for breakfast on 07/24/18 and 07/25/18 as requested. This affected two of 23 residents observed during meals. Findings Include: A review of the facility policy titled,Accuracy and Quality of Tray Line Service with a 2010 date, revealed the following: . 7. Each tray will be checked for: . *Special requests (food preferences) . 1) RI #83 was readmitted to the facility on [DATE]. A review of RI #83's most recent Minimum Data Set (MDS), dated [DATE], revealed the resident was cognitively intact. A review of RI #83's care plan for at risk for alteration in nutritional status and weight fluctuation, with an onset date of 03/13/18 revealed: . [...]

Inspectors wroteBased on observation, interview, medical record review, and the facility's policies titled, Assisting the Resident with In-Room Meals, and Adaptive Eating Devices, the facility failed to ensure RI #85's weighted spoon was provided during the breakfast and lunch meals on 07/24/18. This affected one of one resident observed for weighted utensil use during meals. Findings Include: A review of the facility's policy titled, Assisting the Resident with In-Room Meals with a revised date of December 2013 revealed: Purpose .The purpose of this procedure is to provide assistance for residents who choose to receive meals in their rooms . 4. Ensure that the necessary non-food items, ( . special devices, .) are on the tray. Equipments and Supplies The following equipment and supplies will be necessary when performing this procedure: . 3. Special feeding devices (as indicated) . [...]

Inspectors wroteBased on observation, interview and a facility policy titled, Standard Precautions Infection Control, the facility failed to ensure staff washed their hands before gloves were applied, after gloves were removed and before touching personal items of residents. This affected Resident Identifier (RI) # 88 and #39, two of four residents observed during medication administration.

Inspectors wroteBased on observation and review of the facility's policy titled, . Environmental Services Policies and Procedures, the facility failed to ensure vinyl gloves were secured in bags inside the dumpsters and were not lying loose on the ground outside of the dumpsters. This had the potential to attract rodents and pests. This was observed on one of three days of the survey and had the potential to affect all 95 residents that reside in the facility.