Dickson Health and Rehab

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to provide care to ensure that acceptable parameters of nutritional status were maintained and dietary recommendations were reviewed and implemented for 3 of 3 (Resident #2, #6, #7) residents reviewed for weight loss.

Inspectors wroteBased on facility policy review, medical record review, observation, and interview, the facility failed to follow Physician's orders for 5 of 7 (Resident #8, #13, #15, #17 and #60) residents and the facility failed to have orders for oxygen administration and tracheostomy care for 2 of 7 (Resident #62 and #70) reviewed for respiratory care.

Inspectors wroteBased on policy review, employee time sheet review, and interview, the facility failed to ensure a Registered Nurse (RN) was on duty for at least 8 consecutive hours a day, 7 days a week, for 11 of 31 days reviewed and failed to ensure the facility had an RN that was not the Director of Nursing (DON) when the census was above 60 for 7 of 31 days reviewed.

Inspectors wroteBased on policy review and interview the facility failed to ensure employment of a qualified Infection Preventionist to monitor and maintain the facility's Infection Prevention and Control Program. This had the potential to affected 65 of 65 residents residing in the facility.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to ensure medications were properly stored and secured when 2 of 5 (Licensed Practical Nurse (LPN) A and LPN B) nurses left 2 of 6 (North Hall medication cart and North Hall treatment cart) medication storage areas unsecured and unattended.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to maintain and ensure the prevention and spread of infection when 1of 1 (Licensed Practical Nurse (LPN) A) nurses failed to perform hand hygiene between glove changes for 1 of 2 (Resident #32) sampled for wound care and when 1 of 3 (LPN B) nurses failed to wear Personal Protective Equipment (PPE) during enteral medication administration for 1 of 1 (Resident #62) sampled resident observed for medication administration by way of (via) percutaneous endoscopic gastrostomy (PEG) tube

Inspectors wroteBased on policy review, kitchen sanitation logs, refrigerator temperature logs, observation, and interview, the facility failed to ensure food was served under sanitary conditions when the kitchen floor was dirty with pieces of paper scattered on the floor, a black rubber floor mat was sticky and had crumbs and particles under it, the deep fryer had a sticky build up, the oven handles were sticky and the oven had crumbs in it, and 3 dry food storage bins had crumbs and thick sticky area in the outer edge of the lids. The facility failed to log refrigerator temperatures on the nutrition refrigerator and had an undated item in it. The facility had a census of 62 with 62 of those residents receiving a tray from the kitchen.

Inspectors wroteBased on policy review, Center for Disease Control (CDC) Guidelines, Enhanced Barrier Precaution (EBP) Signage, medical record review, observation, and interview, the facility failed to ensure proper infection control practices were maintained when 3 of 6 (Certified Nursing Assistants (CNA) D, L, and O) staff members failed to perform hand hygiene during meal pass and placed dirty trays on the cart with clean trays and when Personal Protective Equipment (PPE) was not used or contained appropriately. The facility failed to don PPE when performing wound care for 2 (Resident #1 and Resident #8) of 4 residents reviewed.

Inspectors wroteBased on policy review, review of facility Infection Surveillance monitoring documents, and interview, the facility failed to establish and implement a program to identify, report, investigate and control infections and communicable diseases when staff (Licensed Practical Nurse (LPN) G) failed to track organisms being treated in the facility and monitor for outbreaks and cross contamination. This had the potential to affect 62 of 62 residents in the facility.

Inspectors wroteBased on review of the Centers for Medicare & Medicaid Services guidelines and interviews the facility failed to provide a qualified Infection Control Preventionist who was responsible to monitor and maintain the facility's Infection Prevention and Control Program. This could have affected 62 out of 62 residents currently residing in the facility.

Inspectors wroteBased on policy review, medical record review, observation, and interviews the facility failed to honor food preferences for 1 of 24 (Resident #35) residents.

Inspectors wroteBased on review of the Resident Assessment Instrument (RAI) Version 3.0 Manual, medical record review, and interview, the facility failed to complete a comprehensive resident admission assessment within 14 calendar days after admission for 1 of 21 residents (Resident #215) sampled residents reviewed.

Inspectors wroteBased on review of the Centers for Medicare and Medicaid Services (CMS) Resident Assessment Instrument (RAI) Version 3.0 Manual, medical record review and interview, the facility failed to complete a significant change assessment for 1 resident (Resident #57) of 21 residents reviewed.

Inspectors wroteBased on review of the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual, medical record review, and interview, the facility failed to complete resident assessments, using the Centers for Medicare & Medicaid Services-specific RAI (Resident Assessment Instrument) process, within the regulatory time frames for 2 of 21 sampled residents (Resident #28 and #48) reviewed for completion of the MDS resident assessments.

Inspectors wroteBased on facility policy review, medical record review, observation, and interview, the facility failed to develop comprehensive care plans for 2 of 21 (Residents #55 and #215) sampled residents.

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to update or revise the care plans for 4 of 21 (Resident #55, #56, #57, and #220) sampled residents reviewed.

Inspectors wroteBased on facility policy review, medical record review, observations, and interviews, the facility failed to ensure 1 of 21 sampled residents (Resident #215) had clean and groomed fingernails.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to follow Physician orders related to parameters for the use of as needed (PRN) pain medication for 1 of 5 sampled residents (Resident #44) reviewed for unnecessary medications; and related to Percutaneous Endoscopic Gastrostomy (PEG) medication administration for 1 of 6 sampled residents (Resident #3) reviewed for medication administration, and failed to collaborate care with Hospice Services for 1 of 3 sampled residents (Resident #515) reviewed for Hospice.

Inspectors wroteBased on the facility policy, facility list of residents that wander, medical record review, observation and interview the facility failed to provide an environment free of accident hazards for 1 of 21 (Resident #34) sampled residents when nursing staff left razors open and unattended on a table in Resident #34's room.

Inspectors wroteBased on policy review, medical record review and interview, the facility failed to have a physician's order for a resident's dialysis treatments, failed to assess and monitor the dialysis site for a thrill (palpable vibration felt over a vessel), and infection, failed to weigh or get vital signs, and failed to have an accurate individualized care plan for 1 of 1 (Resident #48) sampled residents for dialysis.

Inspectors wroteBased on policy review, medical record review, observation, and interview the facility failed to obtain a Physician's Order for hospice care and a foley catheter for 1 of 21 (Resident #53) sampled residents.

Inspectors wroteBased on the facility policy review, record review, and interviews, the facility failed to maintain Registered Nurse (RN) Coverage for 8 consecutive hours a day 7 days a week.

Inspectors wroteBased on policy review, medical record review, and interview, the facility failed to provide evidence of a monthly pharmacist drug regimen review for 2 of 5 sampled residents (Residents #38 and #44) reviewed for unnecessary medications.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to ensure medications were properly and securely stored when medications were left unattended on 1 of 4 medication carts (medication cart #1) and the facility failed to date an opened multi-dose vial of refrigerated Tuberculin Purified Protein Derivative (aids in the detection of infection) in the medication refrigerator in 1 of 2 (East) medication rooms.

Inspectors wroteBased on review of facility policy, Quarterly Payroll Based Journal (PBJ), and interview the facility failed maintain adequate staffing on the weekend for 3 of 4 Quarters in 2024. The facility failed to maintain higher than a One Star Staffing Rating for 4 of 4 Quarters.

Inspectors wroteBased on policy review, medical record review, observation, and interview, the facility failed to promote and maintain residents' dignity when staff failed to provide a privacy bag for 2 of 6 sampled residents (Resident #9 and #17) reviewed with indwelling urinary catheters.

Inspectors wroteBased on policy review, employee file review, payroll time punch review, and interview, the facility failed to implement and follow their abuse policies when employee background checks were not performed for 2 of 8 staff (Registered Nurse (RN) #1 and Dietary [NAME] #1) reviewed for abuse and neglect.

Inspectors wroteBased on policy review, observation, and interview, the facility failed to properly store and maintain medications safely when 1 of 3 nurses (Licensed Practical Nurse (LPN) #2) left medications unattended and out of sight for 2 of 4 sampled residents (Resident #18 and #34) observed during medication administration.

Inspectors wroteBased on policy review, Centers for Disease Control (CDC) Guidelines review, medical record review, observation, and interview, the facility failed to ensure practices to prevent the potential spread of infection were maintained for 1 of 1 sampled resident (Resident #17) reviewed in isolation when the resident was observed out of the room and with other residents, and when 1 of 1 nurse (Licensed Practical Nurse (LPN) #1) failed to perform hand hygiene during wound care.