Delmar Gardens of Smyrna

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility policy titled, Medication Expiration Guidelines, the facility failed to discard expired supplements in two of two medication rooms and on two of four medication carts. This deficient practice created the potential for expired or improperly stored supplements to be used in resident care, placing residents at risk for compromised safety, potential adverse consequences. Findings Include:Review of the facility's policy Medication Expiration Guidelines revealed under section Oral Guidelines: If the liquid is dispensed in the manufactures bottle, the expiration date is the manufacturer's expiration date printed on the actual medication bottle. [...]

Inspectors wroteBased on observations, staff interview and record review, the facility failed to follow physician's orders to administer a nutritional enteral feeding and hydration according to the physician orders for one of three residents (R) (R99) receiving tube feeding in the facility. The deficient practice had the potential for the resident not to receive the correct amount of nutrition ordered by the physician which could result in a negative outcome for the resident.

Inspectors wroteBased on staff interviews, record review, and review of the facility policy titled, Abuse, Neglect, and Exploitation, Freedom From, the facility failed to protect the residents' right to be free from misappropriation of property for one of eight sampled residents (R ) (R1). Specifically, R1 had her bank card stolen from her handbag stored in her closet.

Inspectors wroteBased on record review, staff interviews, and review of the facility policy tilted, Abuse, Neglect, and Exploitation, Free From, the facility failed to protect residents from sexual abuse by another resident by not immediately reporting nonconsensual sexual abuse between two resident (R) (R2) and (R3). The deficient practice diminished the facility's potential to protect R2 from possible future abuse and ensure a safe environment for other residents.

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility's policies titled, Handling of Soiled Linen and Resident Clothing, Isolation Precautions/Transmission Based Precautions, Hand Washing, and Cleaning Guidelines for Resident Care Equipment, the facility failed to ensure infection control procedures were followed. Specifically, the facility failed to ensure clean linen was covered during transport on one of five halls, failed to ensure Transmission Based Precautions (TBP) were followed for one resident (R) (R40) on TBP, failed to ensure a continuous positive airway pressure (CPAP) mask was properly stored when not in use for one R (R85), failed to ensure proper hand hygiene during medication pass, and failed to ensure shared medical equipment was cleaned between resident use. [...]

Inspectors wroteBased on observation, staff and resident interviews, record review, and review of the facility-provided document titled, Residents' Rights, the facility failed to maintain dignity by ensuring a dignity bag was provided for one of five residents (R) (R48) who had an indwelling urinary catheter. This deficient practice had the potential to diminish the resident's quality of life in an environment that promotes the maintenance or enhancement of each resident's quality of life.

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility policy titled, Medications, Self-Administration of, the facility failed to ensure unauthorized medications were not stored at the bedside for one of 28 sampled residents (R) (R85). This deficient practice had the potential to allow unauthorized access to unsecured medications to R85, other residents, and visitors.

Inspectors wroteBased on observations, staff interviews, records review, and review of the facility policy titled, Care Management, the facility failed to ensure reasonable accommodation of needs was provided for one of 28 sampled residents (R) (R62) related to providing a wheelchair to accommodate a physician's order to elevate both feet at all times. The deficient practice had the potential to place R62 at risk for medical complications, unmet needs, and a diminished quality of life. Findings Include 1. Review of the facility policy titled, Care Management, revised 5/2021, revealed the Policy section included A. All Resident care is designed to meet a resident's individual needs and is directed toward conservation and restoration of an optimal physical and emotional state. Review of R62's electronic medical record (EMR) revealed diagnoses including impaired mobility and reperfusion edema. [...]

Inspectors wroteBased on observations, staff and family interviews, record review, and a review of the facility policy titled, Condition Change of the Resident, the facility failed to promptly notify the responsible party of a change in condition for one of 19 residents (R) (R62) reviewed for change in condition related to a deep tissue injury.

Inspectors wroteBased on observations, staff and resident interviews, and record review, the facility failed to provide accurate Minimum Data Set (MDS) assessment data for two of 28 sampled residents (R) (R26 and R40). This deficient practice had the potential to affect the assessment of R26 and R40's care needs.

Inspectors wroteBased on observations, staff interviews, record review, and review of the facility policy titled, Care Plan Conference Interdisciplinary, the facility failed to develop a baseline care plan for enteral tube feeding for one of three residents (R) (R502) who received enteral tube feeding, within 48 hours of admission. This deficient practice had the potential to place R502 at risk for not receiving treatment and/or care according to their needs.

Inspectors wroteBased on observations, resident and staff interviews, record review, and review of the facility policy titled, Care Plan Conference Interdisciplinary, the facility failed to ensure a comprehensive person-centered care plan was developed for one of seven residents (R) (R26) reviewed for the use of unnecessary medications. This deficient practice had the potential to place R26 at risk for not receiving treatment and/or care according to their needs.

Inspectors wroteBased on observations, staff and resident interviews, record review, and review of the facility's policy titled, Shaving, the facility failed to provide Activities of Daily Living (ADL) care for one of 28 sampled residents (R) (R21). Specifically, the facility failed to remove excessive facial hair for R21. This deficient practice placed R21 at risk for unmet needs and a diminished quality of life.

Inspectors wroteBased on staff interviews, record review, and review of the facility's policy titled, Hemodialysis, the facility failed to ensure communication between the facility and dialysis center was documented after each dialysis session for one of one resident (R) (R85) reviewed for dialysis care. The deficient practice had the potential to place the resident at risk for medical complications, unmet needs, and a diminished quality of life. The sample size was 25.

Inspectors wroteBased on observations, resident and staff interviews, record review, and review of the facility policy titled, Bed Mobility Assist Devices, the facility failed to ensure one of six residents (R) (R63) reviewed had the necessary consent, physician's order and completed assessment for the use of bilateral half-side rails on their bed. This deficient practice had the potential to place R63 at risk of physical injury and entrapment.

Inspectors wroteBased on interviews, record review, and review of the facility's policy titled, Behaviors Using Person-Centered Care, Accommodating, the facility failed to ensure psychotropic medications were not ordered as needed (PRN) for more than 14 days unless clinically indicated for one of seven residents (R) (R31) reviewed for the use of unnecessary medications. This deficient practice had the potential to affect R31's highest practicable mental, physical, and psychosocial well-being.

Inspectors wroteAMENDED 8/31/23 Based on record review, family and staff interviews, and review of the policy titled Abuse, Neglect and Exploitation, Freedom From, the facility failed to thoroughly investigate and follow-up on an allegation of verbal abuse for one of 32 sampled residents (R) (R#53). Actual harm was identified to have occurred on 8/2/23 when Administrations was made aware that R#53 made an alligation of abuse and failed to complete a though investigation. During an interview on 8/9/23 2:54 p.m. with R#53 revealed she is still scared for her life.

Inspectors wroteBased on observations, staff interviews, and review of the facility policy titled, All foods stored will be properly labeled according to the following guidelines the facility failed to ensure opened food items in the refrigerator and the dry storage room were properly labeled and dated; and failed to dry cleaned dishes appropriately. This deficient practice affects 98 of 100 residents.

Inspectors wroteBased on observations, record review, staff interviews, the facility failed: (1) to ensure that comfortable water temperatures were maintained for 11 of 66 resident rooms (Rooms 9222, 9224, 9225, 9226, 9227, 9228, 9229, 9230, 9231, 9232, and 9233); (2) to ensure that the facility was maintained in a safe, clean, and comfortable home-like environment for three of 66 resident rooms (rooms [ROOM NUMBER]) related to unlabeled and unbagged contoured bedpan, fracture bedpan, graduated urinal containers, specimen collector pans, wash basins, and a dirty bedside toilet commode.

Inspectors wroteBased on record review, family and staff interviews, and review of the policy titled Abuse, Neglect and Exploitation, Freedom From, the facility failed to ensure that an allegation of verbal abuse was reported to the State Agency (SA) for one of 32 sampled residents (R) (R#53) in a timely manner of within the required two hours of discovery.

Inspectors wroteBased on observations, record review, resident and staff interviews and review of the facility policy titled Fall Risk/Prevention Program, the facility failed to follow the care plan related to fall prevention interventions for one of 32 residents (R) (R#77).

Inspectors wroteBased on observations, record review, and interviews, the facility failed to ensure that Activities of Daily Living (ADL) care was provided for dependent residents for two of 32 sampled residents (R) (R#31 and R#68) related to nail care for R#31 and shower assistance for R#68.

Inspectors wroteBased on observations, interviews and record review, the facility failed to follow physician orders and store oxygen equipment properly for one of 32 sampled residents (R) (R#77).