Crossings at East Lake of Journey LLC, the

Inspectors wroteBased on observations, staff and resident interviews, record reviews, and review of facility policies titled, Infection Prevention and Control Program, Infection Preventionist, and Enhanced Barrier Precautions, the facility failed to maintain an effective infection prevention and control program. Specifically, the facility failed to ensure staff consistently used the required Personal Protective Equipment (PPE) in accordance with Enhanced Barrier Precautions (EBP) protocols, failed to conduct required infection surveillance audits, and failed to demonstrate staff competency through completed infection control competency checkoffs. The deficient practices created the potential to contribute to the transmission of infectious organisms among residents, staff, and visitors. [...]

Inspectors wroteBased on observations, resident and staff interviews, record review, and review of the facility's policies titled, Baseline Care Plan and Comprehensive Care Plans, the facility failed to ensure that one of 16 residents (R) (R39) using a specialized mattress had a properly functioning air mattress. The deficient practice had the potential to decrease R39's functional ability and healing progress made while in the facility placing her at increased risk for pressure ulcers/ injuries.

Inspectors wroteBased on record review, staff interviews and review of the facility policy titled, Resident Assessment - Coordination with PASARR Program Date Reviewed/ Revised:12/24/2023 the facility failed to ensure a Preadmission Screening and Resident Review (PASARR) Level two was submitted for two of 21 residents (R) (R3 and R69) reviewed for PASARR II. This deficient practice had the potential to place R3 and R69 at increased risk of not receiving required behavioral health support to meet their daily needs.

Inspectors wroteBased on observations, resident and staff interviews, record review, and a review of the facility's policy titled, Activities of Daily Living (ADLs), the facility failed to ensure one of 42 sampled residents (R) (R13) who was unable to carry out activities of daily living (ADL) received the necessary services to maintain good grooming and good hygiene. This failure had the potential to decrease R13 self-esteem and contribute to psychosocial distress.

Inspectors wroteBased on observations, staff and resident interviews, record review, and review of the facility policy titled, Accidents and Supervision, the facility failed to ensure the environment remained free of accident hazards. Specifically, the facility allowed an electrical appliance capable of producing heat (a clothes iron) to be present and accessible in one resident's (R) (R85) room on a unit that housed residents with wandering behaviors. This deficient practice had the potential to cause burns and fire-related injury.

Inspectors wroteBased on observation, staff interviews, record review, and facility policy review, the facility failed to implement the Care Plan related to a mechanical lift transfer for one of three residents (Resident (R)7) reviewed for mechanical lift transfers in a total sample of 14 residents. The deficient practice placed the residents at risk of harm due to the inappropriate transfers.

Inspectors wroteBased on observations, staff interviews, and record review, the facility failed to follow nutrition orders for one of three residents (Resident (R)5) reviewed who received nutrition via a feeding tube. This failure placed R5 at risk for health complications and weight loss.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement Enhanced Barrier Precautions (EBP) for two of 14 sampled residents (Residents (R) 5 and R9). The facility failed to utilize EBP for R5 and R9, who shared a room and had both gastric and jejunostomy feeding tubes for nutrition. This failure placed the residents at risk of increased transmission of infection.

Inspectors wroteBased on observations, staff and resident interviews, and the review of the facility policy titled, Pest Control Program, the facility failed to maintain an effective pest control program in five of eight resident rooms (Rm102,103,403,407,506).

Inspectors wroteBased on observations, record review, and staff and resident interviews, the facility failed to ensure two of 45 sampled residents (R) (R51 and R38) call lights were accessible and placed within their reach while in bed. This deficient practice had the potential to cause delayed assistance, medical attention and worsening of the residents' medical conditions.

Inspectors wroteBased on observations, resident and staff interviews, record review, and review of the facility-provided document titled Your Rights and Protections as a Nursing Home Resident, the facility failed to honor the resident's right to make a choice for one of 45 sampled residents (R) (R8) related to returning to bed for a nap. The deficient practice had the potential to place R8 at risk for unmet care needs and a diminished quality of life.

Inspectors wroteBased on staff interview and record review, the facility failed to accurately code a fall with major injury on the Minimum Data Set (MDS) for one of three residents (R) R14 reviewed for accidents. This failure had the potential to place R14 at risk for additional falls and an adverse effect on her quality of life and quality of care.

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility's policy titled Restorative Nursing Programs, the facility failed to revise the care plan that addressed the refusals of restorative nursing services for one of 45 sampled residents (R) R8. Specifically, the facility failed to revise the care plan that included alternative interventions for splint usage and Range of Motion (ROM) exercises.

Inspectors wroteBased on observations, resident and staff interviews, record review, and review of the facility's policy titled Activities of Daily Living, the facility failed to provide activities of daily living (ADL) care for three of 45 sampled residents (R) (R8, R38, and R16) according to the resident's care needs. Specifically, the facility failed to ensure R8 and R38 received nail care and failed to ensure R16 received a bath or shower. This deficient practice had the potential to place R8, R38, and R16 at risk for unmet needs and a diminished quality of life. Findings Include: A review of the facility's policy titled Activities of Daily Living, dated 2/1/2022, revealed the Policy section included . Care and services will be provided for the following activities of daily living: 1. Bathing, dressing, grooming, and oral care. The Policy Explanation and Compliance Guidelines section included . 3. [...]

Inspectors wroteBased on observation, staff and resident interviews, record review and review of the facility's policy titled Restorative Nursing Programs, the facility failed to provide evidence that restorative services for splinting and range of motion (ROM) were consistently provided for one of four residents (R) (R8) reviewed for rehab and restorative nursing services.

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility's policies titled, Medication Storage and Storage of Medications, the facility failed to lock two of four (100-Hall and 200-Hall) medication carts when not in use and failed to remove expired medications from two of four (100-Hall and 500-Hall) medication carts.

Inspectors wroteBased on staff interviews, record review, and review of the facility's policy titled Restorative Nursing Programs, the facility failed to complete, maintain, and make readily accessible accurate documentation of medical records for one of four residents (R) (R8) reviewed for rehab and restorative nursing services.

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility's policy titled Hand Hygiene, the facility failed to maintain infection control protocol by not practicing hand hygiene during wound care for one of three residents (R) R64 receiving wound care. The deficient practice had the potential to increase the risk of infection due to cross-contamination and the potential to increase the risk of spread of infection to R64 and other residents.

Inspectors wroteBased on observations, record review, interviews, and policy review titled Comprehensive Care Plans, the facility failed to develop and implement person-centered comprehensive care plans for three of 34 sampled residents (R). Specifically, facility failed to maintain emergency trach supplies in the facility and at the bedside for R69; failed to develop a care plan for the use of Continuous Positive Airway Pressure (CPAP) and failed to indicate the accurate code status for Advanced Directive (AD) for R19. On September 29, 2023, a determination was made that a situation in which the facility's noncompliance with one or more requirements of participation had caused, or had the likelihood to cause, serious injury, harm, impairment, or death to residents. [...]

Inspectors wroteBased on observations, record review, staff interviews, and review of the policy titled Tracheostomy Care, the facility failed to ensure staff were trained for emergency care of tracheostomies (trachs) and provide emergency tracheostomy kits for one resident (R) R69 reviewed for tracheostomy care. The facility's failure to train staff and provide emergency tracheostomy kits in the event that the resident's airway was compromised, resulted in R69 trach tube becoming dislodged and an emergency room visit to have tube re-inserted. In addition, the facility failed to properly store resident respiratory care equipment when not in use for R19's Continuous Positive Airway Pressure (C-PAP) mask and for R70's nebulizer mask. There were 18 residents receiving respiratory services. [...]

Inspectors wroteBased on observations, record review, interviews, review of the facility assessment, and review of job descriptions for the Administrator and the Director of Nursing (DON), the facility administration failed to provide oversight and monitoring to ensure that competent nursing staff are available and trained to care for residents admitted with special care needs (such as care for a tracheostomy- a surgical procedure to open a direct airway through an incision in the trachea/windpipe). In addition, administration failed to ensure open communication between nursing staff to facilitate ordering of supplies needed to care for a resident with a tracheostomy and ensure there were emergency tracheostomy supplies available at bedside and crash cart for one resident (R) R69 sampled for tracheostomy care. [...]

Inspectors wroteBased on observations, record review, staff interviews, and review of policies titled Abuse, Neglect, and Exploitation and Background Investigations, the facility failed to obtain a criminal background check which included a State and Federal Bureau of Investigation (FBI) fingerprint check through the Georgia Criminal History Check System (GCHEXS) for the Administrator of the facility. The census was 96.

Inspectors wroteBased on observations, record review, interviews, and review of the policy titled, Safe Water Temperatures, the facility failed to ensure comfortable hot water temperatures were maintained below 120 degrees Fahrenheit (F) on five of five halls and in two of two shower rooms. The facility census was 96.

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility policies titled, Tracheostomy Care, Hand Hygiene, Infection Prevention and Control Program, and Linen Operation, the facility failed to maintain an infection prevention and control program to help prevent the development and transmission of infections per national standards and guidelines. Specifically, staff failed to wash/sanitize hands and change gloves during tracheostomy care for one of one resident (R) R69 reviewed for tracheostomy care and failed to ensure infection control policies were followed during handling, storage, and processing of linens, cleaning of lint traps, and personal items in the clean storage laundry. These deficient practices had the potential to spread infection to 96 residents residing in the facility.

Inspectors wroteBased on observations, staff interviews, and review of the facility policy titled, Safe and Homelike Environment the facility failed to ensure a clean, comfortable, and homelike environment. This was evidenced by grime build up in five of six resident bathrooms on the 500 hall; grime and dust build up on air conditioner (AC) units in three of six rooms on the 500 hall; a hole in a resident's bathroom door on the 100 hall; a loose handrail on the 100 hall; grime build up on the wall in resident room on the 100 hall; loose dusty dry wall and loose cracked baseboards in the facility laundry room. The census was 96.

Inspectors wroteBased on observations, record review, interviews, and review of facility policy's titled Medication Storage and Resident Self-Administration of Medication, the facility failed to assess and determine if one resident (R) R#70 of 34 sampled residents, for the ability to safely self-administer medications left at the bedside.

Inspectors wroteBased on observations, record review, and staff interviews, the facility failed to obtain a Physician's Order (PO) for an indwelling catheter for one of four sampled residents (R) R349.

Inspectors wroteBased on record review, staff interviews, and review of policy titled Medication Regimen Review and Use of Psychotropic Medication, the facility failed to document the intended duration of therapy for one resident (R) R20 that had orders for as needed (PRN) antianxiety medications beyond 14 days of five residents reviewed for unnecessary medications.

Inspectors wroteBased on closed record review, staff interview and review of the facility policy titled Medication Administration the facility failed to administer medications according to the hospital discharge Physicians Order for one resident (R) R97 of three closed record reviews.