Dadeville Healthcare Center

Inspectors wroteBased on observations, interviews, record review, and policy review, the facility failed to provide services to three of eight residents (Resident Identifier (RI) #67, #11, and #73) reviewed for limitations in range of motion (ROM) in a total sample of 23. The facility failed to assess residents with ROM impairments and provide services to maintain function or prevent declines. In addition, the facility failed to implement established restorative programs for residents with programs in place.

Inspectors wroteBased on observation and interviews, the facility failed to keep medications under safe and secure storage with limited access and under direct observation of authorized staff for one of six medication carts observed. In addition, the facility failed to ensure insulin vials and pens were dated when opened for four of six medication carts observed which affected six of 21 residents identified by the facility as having used insulin.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure three of three residents (Resident Identifier (RI) #28, RI #50 and RI #282) reviewed for oxygen (O2) therapy in a sample of 23 residents received O2 therapy with equipment that was cleaned and stored in a way to prevent possible contamination. The concentrators had dusty filters and the nasal cannulas were not dated to indicated when the tubing had been changed and the nasal cannulas were not placed in a bag when not in use. This deficient practice had the potential to allow residents to receive therapy with equipment that was not stored properly between uses and increased their risk of infection and/or illness.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide dignity in toileting for one of 23 sampled residents (Resident Identifier (RI) #8). The facility staff failed to provide RI #8 with interventions, such as assisting to the bathroom, a bedside commode, or bed pan, to remain continent but instead provided adult briefs for bowel and bladder function.

Inspectors wroteBased on record review and interview, the facility failed to provide written notice of a transfer for one of one resident (Resident Identifier (RI) #31) reviewed for hospital transfers to the resident and the resident representative when the resident was transferred to the hospital; and failed to notify the State office of the Ombudsman of resident transfers.

Inspectors wroteBased on observation, interview, and record review, the facility failed to have an effective system to identify safety risks related to side rails for one of one resident (Resident Identifier (RI) #11) reviewed for side rails. The facility failed to ensure the correct assessed side rail was utilized to prevent potential accidents hazards.

Inspectors wroteBased on observation, interview, record review, and policy review, the facility failed to ensure one out of five residents reviewed for unnecessary medications (Resident Identifier (RI)# 47) had a medication regimen free of unnecessary medications. The resident was prescribed as needed (PRN) antipsychotic medication without a stop order and without a physician re-evaluation after 14 days.

Inspectors wroteBased on interview and a review of the facility policy titled Abuse, Neglect, Misappropriation of Resident Property, Exploitation, and Injuries of Unknown Source, the facility failed to ensure an allegation of abuse, involving Resident Identifier (RI) #155, was reported to the State Agency (SA). This affected one of three sampled residents reviewed for abuse. A review of a facility policy titled, Abuse, Misappropriation of Resident Property, Exploitation, and Injuries of Unknown Source, with an effective date of 11/28/2016, revealed: PURPOSE: To ensure the safety and well-being of each resident, the facility will promote and protect the rights of each resident. VII. REPORTING /RESPONSE A. In response to allegations of abuse . are reported immediately, but not later than 2 hours after the allegation is made . to other officials (including to the State Survey Agency .). [...]

Inspectors wroteBased on interviews, record review, and review of annual Certified Nursing Assistant (CNA) competency/performance review documentation, the facility failed to ensure a system was in place to assess CNAs performance at least once every twelve months. This affected three of three CNAs reviewed and had the potential to affect all 86 residents residing in the facility.

Inspectors wroteBased on interviews, review of the Form Instructions for the Notice of Medicare Non-Coverage (NOMNC) CMS-10095 and Form Instructions Advance Beneficiary Notice of Noncoverage (ABN), and review of Resident Indentifer (RI)# 54's beneficiary notifications, the facility failed to ensure Resident #54 and/or the resident representative were issued beneficiary liability notices at least two days prior to the end of Medicare Part A covered days. This affected one of three residents reviewed for liability notices.

Inspectors wroteBased on record review, interviews, and review of facility's Resident admission Checklist, the facility failed to ensure Resident Indentifer (RI)# 88 had orders in place from the time of admission, addressing the need for oxygen. This affected one of 21 residents for whom physician's orders were reviewed

Inspectors wroteBased on record review and interviews, the facility failed to ensure a Significant Change in Status Minimum Data Set (MDS) Assessment was initiated after a decline in two areas, indwelling urinary catheter and pressure ulcer. This affected Resident Identifier (RI) #72one of 21 residents for whom MDS assessments were reviewed.

Inspectors wroteBased on record review and interviews, the facility failed to ensure: 1) Resident Identifier (RI) #35's dialysis care plan approach to monitor fluid intake was implemented; 2) A care plan was developed to address RI #72's catheter. These failures affected 2 of 21 residents for whom care plans were reviewed.

Inspectors wroteBased on record review, interviews, and review of [NAME] and [NAME], Fundamentals of Nursing, EIGHTH EDITION, the facility failed to ensure staff completed an order for O2 (oxygen) saturations every shift for five days from 9/27-10/1/2017. This affected one of 21 residents for whom physician's orders were reviewed.

Inspectors wroteBased on record review and interviews, the facility failed to ensure staff monitored Resident #35's fluid intake, a resident dependent on hemodialysis with orders for fluid restriction. This affected one of three residents reviewed for Dialysis.

Inspectors wroteBased on record review, interviews, and review of [NAME] and [NAME], Fundamentals of Nursing, EIGHTH EDITION, the facility failed to ensure nursing staff documented in Resident #88's medical record that the resident collapsed while being assisted to the bathroom on [DATE]. Further, nursing staff did not document their response to Resident #88, including resuscitation efforts, or the subsequent need to transfer him/her to the hospital. This affected one of 21 residents for whom medical records were reviewed.