Crossville Health and Rehabilitation, LLC

Inspectors wroteBased on observation, interviews, record review, and review of the Centers for Medicare & (and) Medicaid Services Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual, the facility failed to ensure Resident Identifier (RI) #74's Quarterly Minimum Data Set (MDS) assessment dated [DATE], and RI #120's Quarterly MDS assessment dated [DATE], was accurately coded to reflect the residents received Dialysis treatments during these assessment periods. This affected RI #74 and RI #120, two of 33 sampled residents for whom MDS assessments were reviewed. Findings Include: A review of the Centers for Medicare & Medicaid Services Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual, Version 1.17.1, dated 10/2019 revealed the following: . SECTION O: SPECIAL TREATMENTS, PROCEDURES, AND PROGRAMS Intent: [...]

Inspectors wroteBased on observation and interviews, the facility failed to ensure licensed staff did not place the end of the tubing from the tube feeding bottle on the bed covers of Resident Identifier (RI) #113 after disconnecting the tubing from the resident, prior to administering medications by gastrostomy tube. This affected RI #113, one of two residents observed receiving medications by gastrostomy tube. Findings Include: RI #113 was admitted to the facility on [DATE] and readmitted on [DATE], with diagnoses of Dysphagia and Gastrostomy Status. A review of RI #113's November 2021 Physician Orders revealed RI #113 was to receive Keppra and Topamax per gastrostomy tube. On 11/02/2021 at 4:11 PM, Employer Identifier (EI) #5, a Licensed Practical Nurse (LPN) was observed giving medications to RI #113. EI #5 prepared the Topamax and Keppra for administration by Gastrostomy tube. [...]

Inspectors wroteBased on observation, interview and review of a facility policy tilted Hand Hygiene, the facility failed to ensure Employee Identifier (EI) # 1, Certified Nursing Assistant (CNA), washed and sanitized her hands while feeding multiple residents lunch on 11/14/19 in the dining room. This affected four residents, during one of three dining observations in the dining room. Findings Include: A review of a facility policy titled Hand Hygiene, dated November 14, 2016, revealed the following: Hand washing should be performed between procedures with resident/guest(s) based upon the principle that all blood, bodily fluids, secretions, excretions (except sweat), no-intact skin, and mucus membranes may contain transmissible infectious agents . On 11/14/19 at 11:58 a.m., the surveyor observed EI #1 sitting in front of four residents at a table in the dining room. [...]

Inspectors wroteBased on observations, interview, review of a facility policy titled Cleaning of Miscellaneous Equipment and Utensils and review of the 2017 U.S. (United States) Public Health Service Food Code, the facility failed to ensure: 1) a container of mustard in the walk-in-cooler did not have mustard on the outside of the container on two of four days of the survey; 2) a scoop was not stored in the flour bin on the initial tour of the kitchen and 3) dust particles were not observed on the back of the oven, and on pipes above the area where desserts and breads were prepared. This was observed on one of four days of the survey. These deficient practices had the potential to affect all 135 residents receiving meals from the dietary department. Findings Include: [...]

Inspectors wroteBased on observations, interviews, and a review of the facility's policy titled, Privacy Upon Entering Resident's Room, the facility failed to ensure staff knocked and requested permission prior to entering Resident Identifier ( RI) #31's room. This affected one of 37 sampled resident's room observed for resident's privacy. Findings Include: A review of the facility's policy titled, Privacy Upon Entering Resident's Room with an effective date of 11/06/14, revealed the following: PURPOSE: The resident has the right to privacy .PROCESS: 1. Prior to entering Resident's room, knock on door and ask permission to enter. RI #31 was re-admitted to the facility on [DATE] with diagnoses including Muscle Weakness and Chest Pain. [...]

Inspectors wroteBased on observations, interviews and record review, the facility failed to ensure a smoking assessment was completed for Resident Identifier (RI) #106 when the resident was identified as being a smoker. This deficient practice affected RI #106, one of six residents sampled for smoking. Findings Include: RI #106 was admitted to the facility on [DATE], with a diagnosis of Nicotine Dependence. RI #106's admission Minimum Data Set (MDS) assessment, with an Assessment Reference Date of 08/26/18, assessed RI #106 as scoring a 13 on the Brief Interview for Mental Status indicating RI #106 was cognitively intact. On 09/25/18 at 2:21 p.m., RI #106 shared with the surveyor that he/she smoked and smoked before being admitted to facility. On 09/25/18 at 2:32 p.m., the surveyor observed RI #106 smoking in the smoking area with other residents. [...]

Inspectors wroteBased on observation, interviews, medical record review and a review of the facility's policy titled, Person Centered Care Plans the facility filed to ensure Resident Identifier (RI) #98's care plan was followed for staff to provide weight bearing assist during transfer. This affected one of 37 resident's whose care plans were reviewed. Findings Include: A review of the facility's policy titled, Person Centered Care Plans with an effective date of 8/15/18, revealed the following: . STANDARD: . the facility develops and implements a baseline plan of care . that includes the . healthcare information necessary to properly care for the immediate needs of the resident . PROCESS: I . f) the MDSC (Minimum Data Set Coordinator) will ensure care plan intervention(s) are entered into Care Guide ADLs (Activities of Daily Living)/Intervention . [...]

Inspectors wroteBased on observation, interviews, record reviews and a review of the facility's policy titled, Prescriber Medication Orders, the facility failed to ensure a verbal order for Resident Identifier (RI) #95 had all the verbal components upon receipt from the physician. The verbal ordered lacked the time the order was given. This affected one of 39 sampled residents whose physician's orders were reviewed. Findings Include: A review of the facility's policy titled, Prescriber Medication Orders dated 03/11, revealed the following: . Policy Medications are administered only upon the clear, complete, and . order . RI #95 was readmitted to the facility on [DATE] with diagnoses including: Unspecified Dementia, Adjustment Disorder with Depressed Mood and Adjustment Disorder with Anxiety. [...]

Inspectors wroteBased on observations, interviews, and review of the WHO (World Health Organization) recommendations for hand hygiene, and facility policy titled, Dressing - Clean, the facility failed to ensure residents with facility acquired pressure ulcers received wound care in a manner to prevent the potential for cross contamination. This affected RI (Resident Identifier) #22 and RI #60, two of two residents with facility acquired pressure ulcers whose wound care treatments were observed. Findings Include: 1. A review of the medical record revealed RI #22 was admitted to the facility on on 6/15/18 and readmitted on [DATE] with diagnoses to include fracture of femur, with current diagnoses of Pressure ulcer of left buttock and Escherichia coli infection. [...]

Inspectors wroteBased on observations, interviews, record reviews and a review of the facility's policy titled, Incidents and Accidents, the facility failed to ensure: 1. staff did not let go of Resident Identifier (RI) #98 during positioning from standing to sitting in a chair. RI #98 sustained a fall and as a result of this fall, sustained a left calf hematoma and bruising to his/her wrist. RI #98 required x-rays as a result of staff not following RI #98's potential for falls and ADL's care plans, to assist the resident with positioning; 2. RI #44's bedside table did not have gouged areas exposing the particle board and rough edges and 3. RI #87's wheel chair did not have exposed screws protruding from the left front rail of the wheelchair and a tattered torn and rough padding was not exposing foam to the right arm rest. [...]

Inspectors wroteBased on observation, interviews and a review of the facility policy's titled, Storage of Medications and Biologicals, the facility failed to ensure: 1. a bottle of expired Bismatrol 8 ounce (236ml/milliliter) was not left on a medication cart and 2. an expired box of Ear Drops (Carbamide Peroxide 6.5% (percent)-0.5ounce,15ml) was not left on a medication cart. The deficient practices affected two of five medication carts viewed for expired medications. Findings Include: A review of the facility policy's titled, Storage of Medications and Biologicals dated 03/11, revealed the following: . Procedures . 11. Outdated, . medications . are removed from stock . disposed of according to procedures for medication disposal . On 9/27/2018 at10:00 AM, the surveyor conducted a medication cart reviews on the Right Wing. Employee Identifier (EI) #4, LPN/Licensed Practical Nurse was also present. [...]

Inspectors wroteBased on observations, interviews, review of a policy titled, Multidrug Resistant Organism and review of a policy titled, Contact Precautions, the facility failed to ensure the licensed nurse: 1. changed gloves and washed her hands during wound care treatment, after removing contaminated materials from the pressure ulcer cite during care for RI (Resident Identifier) #22 2. utilized appropriate Personal Protective Equipment during care for RI #22 3. disposed of potentially contaminated linens appropriately after wound care for RI #22 and 4. did not use contaminated gloves during wound care for RI #60. This affected RI #22 and RI #60, two of two resident identified with facility acquired pressure ulcers and two of five residents with pressure ulcers. Findings Include: [...]