Crossroads of Flowery Branch of Journey LLC, the

Inspectors wroteBased on staff interviews and record review, the facility failed to ensure the security of all personal funds of residents deposited with the facility. Specifically, the facility failed to maintain a surety bond sufficient to cover the total funds in the resident trust account. This deficient practice had the potential to affect the residents with trust fund accounts managed by the facility. The census was 93 residents.

Inspectors wroteBased on observations, staff and resident interviews, record review, and review of the facility's policy titled Comprehensive Care Plans, the facility failed to develop and implement care plans that describe the resident's medical, nursing, physical, mental, and psychosocial needs for six of 46 sampled residents (R) (R90, R12, R74, R57, R1 and R16).

Inspectors wroteBased on staff interviews, resident interviews, record review, and review of the facility's policy titled Comprehensive Care Plans, the facility failed to provide one of 46 sampled residents (R) (R1) the right to participate in the development of his person-centered plan of care. This deficient practice had the potential to deprive R1's inclusion of personal goals, choices, and preferences in the plan of care.

Inspectors wroteBased on staff interviews, record review, and review of the facility's policy titled Residents' Rights Regarding Treatment and Advance Directives, the facility failed to ensure that the advance directive status was consistently documented in the clinical record for two of 46 sampled residents (R) (R16 and R112).

Inspectors wroteBased on record review, staff interviews, and review of the facility's policy titled Baseline Care Plan, the facility failed to develop a Baseline Care Plan for three of 46 sampled residents (R) (R14, R109, and R90). The deficient practice had the potential for residents' needs to go unmet.

Inspectors wroteBased on observations, staff interviews, resident interviews, record review, and review of the facility's policy titled Medication Administration, the facility failed to follow physician orders in accordance with professional standards related to insulin, blood testing, and non-pressure related wound care for three of 46 sampled residents (R) (R1, R14, and R53). This deficient practice had the potential to create a diminished quality of care.

Inspectors wroteBased on observations, staff interviews, resident interviews, record review, and review of the facility's policies titled, Oxygen Administration and Medication Orders, the facility failed to obtain physician orders for oxygen therapy for one of 13 residents on oxygen and physician orders for Bi-level Positive Airway Pressure (BiPAP) for one of one resident with a BiPAP Mask. Specifically, the facility failed to obtain physician orders for oxygen therapy for residents (R) (R112 and R50). This failure had the potential to cause respiratory distress and inconsistent care for residents receiving oxygen therapy.

Inspectors wroteBased on observations, resident and staff interviews, and record review, the facility failed to ensure that one of two residents (R) (R9) received care and services for the provision of hemodialysis in accordance with professional standards of practice, including ongoing communication and collaboration with the dialysis facility regarding dialysis care and services. This failure had the potential to cause delays in the identification and treatment of dialysis and related complications, including fluid overload, electrolyte imbalances, and access site complications.

Inspectors wroteBased on resident and staff interviews, record review, and review of facility policy, the facility failed to report allegations of staff-to-resident abuse to facility administration and/or within two hours to the State Survey Agency (SSA) for two of three residents (Resident (R) 1 and R2) reviewed for abuse out of a total sample of 12. The deficient practice had the potential to place residents at continued risk of abuse.

Inspectors wroteBased on staff interviews, record review, and review of facility policy, the facility failed to identify and/or investigate allegations of staff-to-resident abuse for two of three residents (Resident (R) 1 and R2) reviewed for abuse out of a total sample of 12. The deficient practice had the potential to allow abuse to continue.

Inspectors wroteBased on observation, staff interviews, record review, and facility policy review, the facility failed to ensure Minimum Data Set (MDS) assessments were accurately coded to reflect a significant weight loss for two of 12 residents (Resident (R) 8 and R5) reviewed. The deficient practice had the potential to result in unmet care needs.

Inspectors wroteBased on observation, resident and staff interviews, record review, and facility policy review, the facility failed to update care plans to reflect a significant weight loss with current intervention for two of 12 residents (Resident (R) 8 and R5) reviewed. The deficient practice had the potential to result in unmet care needs regarding nutrition.

Inspectors wroteBased on observations, resident and staff interviews, record review, and facility policy review, the facility failed to identify a severe weight loss, re-assess nutritional needs, and implement interventions in a timely manner to aid in the prevention of weight loss for two of 12 residents (Resident (R) 8 and R5) reviewed. R8 had a recorded weight loss of 18.65% (percent) in less than three months. R5 had a recorded weight loss of 19.57% in five months.

Inspectors wroteBased on staff interviews, record review, review of the facility's policy titled Nurse Aide Training Program, and review of the Alliant Certified Nursing Assistant (CNA) Annual Report, the facility failed to monitor and verify two of 29 CNAs (CNA AA and CNA FF) completed the minimum required training hours during the last review period of February 1, 2023 - January 31, 2024. The facility census was 87 residents.

Inspectors wroteBased on resident and staff interviews, review of resident council minutes, and review of the facility's policy's titled Resident Council Meeting policy, the facility failed to assure that a follow-up was completed and communicate its decisions related to resident concerns and recommendation voiced during resident council meetings. This deficient practice had the potential to have an adverse effect on any resident who voiced a concern and/or recommendation. The facility census was 87 residents. Findings Include: Review of the facility's policy titled Resident Council Meetings, dated 2/2/2022, under the section titled Policy revealed, This facility supports the rights of residents to organize and participate in residents' groups, including a Resident Council. This policy provides guidance to promoting structure, order, and productivity in these group meetings. [...]

Inspectors wroteBased on observations, resident and staff interviews, and review of the facility's policy titled, Maintenance Inspection, the facility failed to maintain the facility in a safe, clean, comfortable, homelike environment as evidenced by six of 56 resident rooms with furniture and/or packaged terminal air conditioners (PTACs) in disrepair. Specifically, rooms A6-2, B10-1, C18-2 had dressers with missing drawers and/or knobs and rooms C13, C15, C18, and C19 had PTACs that leaked water onto the floors. This deficiency had to potential to diminish the quality of life for the residents in rooms with dilapidated furniture and create a safety hazard for residents in rooms with leaking PTAC units.

Inspectors wroteBased on observations, staff interviews, and review of the facility's policy titled, Hand Hygiene, the facility failed to ensure hand hygiene practices were maintained to prevent the potential for infections and cross contamination. Specifically, the facility failed to perform hand hygiene after passing out each meal tray for residents on one of three halls (Hall A) that was observed during lunch. Findings Include: Review of the facility's policy titled Hand Hygiene, dated February 1, 2022, under the section titled Policy revealed, All staff will perform proper hand hygiene procedures to prevent the spread of infection to other personnel, residents, and visitors. This applies to all staff working in all locations within the facility. Under the section titled Policy Explanation and Compliance Guidelines revealed, 1. [...]

Inspectors wroteBased on staff interviews, record review, and review of the facility's policy titled Documentation in Medical Record, the facility failed to ensure accurate documentation was completed regarding a change of condition for one resident (R) (R1) out of six sampled residents reviewed for notification of change. Findings Include: Review of the undated facility's policy titled, Documentation in Medical Record under Policy revealed, Each resident's medical record shall contain an accurate representation of the actual experiences of the resident and include enough information to provide a picture of the resident's progress through complete, accurate, and timely documentation. Under the section titled Policy Explanation and Compliance Guidelines revealed, 1. [...]

Inspectors wroteBased on observations, interviews, and policy review, the facility failed to ensure staff entering the kitchen wore a hairnet, failed to ensure food items were labeled, dated, and discard after Best Use By date, and failed to ensure dietary staff properly used the three-compartment sink to prevent food borne illness. All 92 residents were receiving an oral diet.

Inspectors wroteBased on observations and staff interviews, the facility failed to ensure the outdoor garbage and refuse area was maintained in a sanitary manner, evidenced by overflowing garbage from the dumpster and the area around the dumpster was clean and free of debris. The facility census was 92.

Inspectors wroteBased on observations and interviews, the facility failed to ensure that essential equipment in the kitchen was in safe working order, evidenced by the walk-in freezer and the reach-in refrigerator observed with ice build-up on the air fans. The facility census was 92 residents.

Inspectors wroteBased on observations, record review, and staff interviews, the facility failed to maintain and discontinue midline intravenous (IV) sites for two residents (R) (R#1 and R#51) reviewed of six residents with a midline IV site.

Inspectors wroteBased on interview and policy review, the facility failed to ensure nursing staff had knowledge of proper reheat procedures for resident food items brought in from outside to prevent food borne illness. The facility census was 92.

Inspectors wroteBased on record review, staff interviews, and review of policy titled Antibiotic Stewardship Program, the facility failed to ensure it implemented an Antibiotic Stewardship Program (ASP) to include antibiotic use protocols, and a system to monitor antibiotic use protocols for three of three months reviewed. This had the potential to affect all 92 residents in the facility.

Inspectors wroteBased on observations, interviews, and review of facility policy, the facility failed to maintain a safe and homelike environment related to disrepair of resident rooms and bathrooms including floors, walls, doors, and heat/air units for 6 of 92 resident rooms.

Inspectors wroteBased on record review, staff interviews, and review of the policy titled Care Plans, Comprehensive Person-Centered, the facility failed to develop a person-centered care plan for one resident (R) (R#345) for right subclavian dialysis access site. In addition, the facility failed to follow the care plan for fluid restriction for R#345. The sample size was 37 residents.

Inspectors wroteBased on observation, record review, interviews, policy review, and Rule 410-10-.02 Standards of Practice for Licensed Practical Nurses, the facility failed to ensure that Licensed Practical Nurse (LPN) NN followed the policy and procedure during medication administration. Specifically, LPN NN prepared medications for R#42, who was not in the facility, and did not destroy narcotics and medications appropriately. The sample size was 37.

Inspectors wroteBased on record review, interviews and review of facility policy, the facility failed to provide restorative services as recommended by occupational and physical therapy for one resident (R)(#31) and related to splint use and contracture management for one resident, R#60, of 37 samples residents.

Inspectors wroteBased on observations, record review, staff interviews, and review of the policy titled, Oxygen Concentrator, the facility failed to ensure oxygen equipment was free from dust build up, failed to deliver oxygen at the flow rate ordered by physician, and failed to ensure oxygen nasal cannulas were properly stored when not in use for four residents (R) (R#14, R#25, R#10 and R#15) receiving respiratory care. The sample size was 37.

Inspectors wroteBased on record review, staff interviews, and policy review, the facility failed to monitor the right subclavian permcath site before and after dialysis and failed to adhere to the ordered fluid restriction for one resident (R) (R#345) reviewed for dialysis services. Review of the facilities Resident Census and Conditions of Residents (CMS Form 672) dated 11/4/22 revealed one resident was receiving dialysis services.

Inspectors wroteBased on record review, policy review, and staff interviews, the facility failed to ensure that psychotropic medications including antianxiety medications were not ordered as needed (PRN) for more than 14 days unless clinically indicated for one of five residents (R) (R#32) reviewed for unnecessary medications.