Diversicare of Bessemer

Inspectors wroteBased on interview; document review; the Rules of the Alabama State Board of Health, Alabama Department of Public Health (ADPH), Chapter 420-5-10, Nursing Facilities; and the facility's job description for Dining Services Director/Account Manager; the facility failed to ensure the full time Dietary Manager, Employee Identifier (EI) #11, met the definition of a Dietary Manager per the rules of the State of Alabama. This had the potential to affect 130 of 130 residents receiving meals from the facility kitchen. Findings Include: The Rules of the Alabama State Board of Health, ADPH, Chapter 420-5-10, Nursing Facilities, original rules effective 8/23/1996 and last amendments effective 7/30/2016 included the following: . 420-5-10-.01 Definitions. (1) Definitions - (a list of selected terms often used in connection with these rules): . [...]

Inspectors wroteBased on observation, interview, the Resident Council Meeting on 11/30/2022, and a test tray on 12/01/2022; the facility failed to ensure scrambled eggs were served warm, palatable, and appetizing in appearance. This had the potential to affect 130 of 130 residents receiving meals from the kitchen. Findings Include: A Resident Council Meeting was conducted on 11/30/2022 at 11:00 AM with fourteen residents attending. During this meeting, the residents attending complained that hot foods were being served cold and the food did not taste good. On 12/01/2022 at 6:40 AM, the steamtable was observed to be setup with breakfast food items. The plate warmer not turned on. Employee Identifier (EI) #13, a Dietary Aide, turned on the plate warmer twenty minutes before the start of trayline. [...]

Inspectors wroteBased on observation, interview, the facility's policy for Food Storage: Cold Foods, and the 2017 Food Code of the United States (U.S.) Public Health Service and U.S. Food and Drug Administration (FDA); the facility failed to ensure: 1.) the dishmachine drain did not extend down into the floor drain, thereby creating the potential for backflow; 2.) food in the Walk-in Cooler was not stored on shelves that were less than six inches from the floor and with accumulated debris on the floor beneath the shelves; and 3.) the surfaces of the dishmachine wall, the shelf beneath the dishtable, and the interior of two food delivery carts were clean. This had the potential to affect 130 of 130 residents receiving meals from the kitchen. Findings Include: 1.) The 2017 Food Code of the U.S. Public Health Service and the FDA included the following: . 5-402.11 BackflowPrevention. (A) . [...]

Inspectors wroteBased on observation, interview, and the 2017 Food Code of the United States (U.S.) Public Health Service and U.S. Food and Drug Administration (FDA); the facility failed to ensure the dumpster area was not littered with unneeded or discarded equipment, which could provide harborage for vermin. This had the potential to affect 138 of 138 residents in the facility. Findings Include: The 2017 Food Code of the U.S. Public Health Service and FDA included the following: . 6-501.114 Maintaining Premises, Unnecessary Items and Litter. The PREMISES shall be free of: (A) Items that are unnecessary to the operation or maintenance of the establishment such as EQUIPMENT that is nonfunctional or no longer used; . On 11/30/2022 at 8:50 AM, the dumpster area was observed with Employee Identifier (EI) #10, the Registered Dietitian (RD). [...]

Inspectors wroteBased on observations, interviews, a copy of Your Resident Rights and Protections Under State and Federal Law, and the facility's Position Description for Maintenance Supervisor, the facility failed to ensure the building was in good repair as evidenced by stained ceiling tiles, loose hand rails, a loose door knob, holes in walls under residents' sinks exposing pipes and adjoining rooms, hole in wall in hallway, broken window with a cut edge open to outside elements/torn window screen, missing sheetrock behind a resident's toilet, toilets leaking/not flushing properly, missing/scraped paint on walls, doors and base boards, detached pieces on residents' doors, black residue under air conditioning (AC) units, sinks and smoke detector, loose baseboards, holes in resident walls, and torn sheetrock under sinks. This affected 3 out of 4 floors of the facility. Findings Include: [...]

Inspectors wroteBased on interview, record review, observations, and review of Centers for Medicare & Medicaid Services (CMS) Long-Term Care Facility Resident Assessment Instrument 3.0 User ' s Manual, the facility failed to ensure Resident Identifier (RI) 120's Minimum Data Set (MDS), with an Annual Assessment Reference Date (ARD) of 09/07/2022 was accurately coded to reflect RI #120 did not have an indwelling catheter. This deficient practice affected RI #120, one of twenty-six sampled resident's whose MDS's were reviewed. Findings Include: The Centers for Medicare & Medicaid Services Long-Term Care Facility Resident Assessment Instrument 3.0 User ' s Manual, dated October 2019, revealed: . SECTION H: BLADDER AND BOWEL Intent: [...]

Inspectors wroteBased on interviews, record review, and review of the Resident Assessment Instrument (RAI) Manual Chapter 4, the facility failed to ensure: 1) a nutritional care plan was implemented for Resident Identifier (RI) #76; and 2) an at risk and actual pressure ulcer care plan was implemented for RI #74. RI #74 developed a pressure ulcer to the sacrum 07/20/2022, which has since healed, however; the facility did not implement an at risk or the actual pressure ulcer care plan. This deficient practice affected RI #74 and 76, two of twenty-six sampled resident's whose plans of care were reviewed.

Inspectors wroteBased on observations, interviews, record review and review of the Unit Managers Duties and Responsibilities, the facility failed to ensure Resident Identifier (RI) #65's nebulizer mask was dated and labeled; and the nebulizer mask was stored in a bag on three of five days of the survey. This deficient practice affected RI #65, one of one resident observed with nebulizer equipment at the bedside.

Inspectors wroteBased on observation, interviews, record reviews and review of a facility policy titled Storage and Expiration Dating of Medications, Biologicals, the facility to store controlled refrigerated Ativan/Lorazapam in a secured non removable box in the medication room. Findings Include: A review of a facility policy titled Storage and Expiration Dating of Medications, Biologicals with a revision date of 7/21/2022, revealed . Procedure .3.1.1 Store all drugs and biolgicals in locked compartments including Schedule II-V medications in a separately, permanently affixed compartments . On 12/01/2022 at 9:05 AM, an observation was made of the medication room with Employee Identifier (EI) #17, Licensed Practical Nurse (LPN). [...]

Inspectors wroteBased on interview, medical record review, the facility's Customer Concern / Grievance Communication Form, the facility's Resident Council Meeting minutes, the facility's Food Preference policy, and the facility's former Daily Alternate List; the facility failed to provide Resident Identifier (RI) #65's long-standing request for Chef Salad at supper on Monday nights and Cottage Cheese with Fruit at supper on Wednesday nights, which she had received for years. This affected RI #65, one of 130 residents receiving meals from the kitchen. Findings Include: The facility's Food Preferences policy, dated May 2014, included the following: Policy Statement It is the center policy that individual food preferences are identified for all residents . food and fluid preferences will be entered into the resident profile in menu management software system. [...]

Inspectors wroteBased on interviews, record reviews and facility policies titled Resident Screening Guidelines and Evaluations, the facility failed to initiate an evaluation for Physical Therapy as indicated by a screening for Resident Identifier (RI) #139. This affected one of one resident sampled for Physical Therapy. Findings Include: A Policy titled, Resident Screening Guidelines with a revision date of 03/14/2018, documented, Policy . that screenings be completed . on all new admission, readmissions, or upon referral by the medical and/or nursing department of a facility .This is done to: .2. Help identify indications of functional loss or aptitude that may require the need for a rehabilitation referral to evaluate for additional skilled services .6. The screening process concludes with one of these possible recommendations: referral for evaluation . [...]

Inspectors wroteBased on an observation, interviews and review of [NAME] and Perry's FUNDAMENTALS OF NURSING, the facility failed to ensure a wound bandage was disposed of in a manner to prevent cross contamination. On 12/12/2022, a wound bandage was observed in one of the shower rooms at the facility. This deficient practice has the potential to affect all residents using one of two shower rooms on one of three floors at the facility.

Inspectors wroteBased on observations, interviews and review of the facility's RESIDENT CENSUS AND CONDITIONS OF RESIDENTS form, the facility failed to ensure the DAILY NURSE STAFFING FORM reflected the census on one of five days of the survey; and reflected the number of staff working on two of five days of the survey. This deficient practice had the potential to affect all 138 residents residing in the facility. Findings Include: A review of the facility's RESIDENT CENSUS AND CONDITIONS OF RESIDENTS form dated 11/29/2022 revealed there were 138 residents residing in the facility during the survey. On 11/28/2022 at 6:10 PM, the surveyor observed the DAILY NURSE STAFFING FORM posted. The census was missing from the form. On 11/30/2022 at 8:29 AM, the surveyor observed the same DAILY NURSE STAFFING FORM from the following day (11/29/2022) posted. [...]

Inspectors wroteBased on observation, interview, record review, and document review, the facility failed to ensure two of 34 sampled residents (Resident Identifier (RI) #74 and RI #69) received nursing care and services in accordance with physician's orders and/or care plans. RI#74 had significant scaly, scabbed, psoriasis noted on the skin of his/her scalp, back, and legs/feet. The skin assessments did not accurately record the resident's skin condition and a medicated cream prescribed by the physician was not implemented. RI #69 had a recent history of a fecal impaction. The resident complained of severe constipation during the survey. Staff failed to monitor and document his/her bowel movements to ensure he/she was not constipated.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide interventions for one of eight residents reviewed for range of motion impairment (Resident Identifier (RI) #74). RI #74) had contractures, including to his/her hands with callused areas observed from where his/her fingernails dug into his/her palms in the sample of 34. The contractures developed and/or worsened over the past year. No interventions had been or were currently in place to address the limitations in range of motion.

Inspectors wroteBased on observation, interview, record review and facility policy review, the facility failed to ensure the kitchen staff adhered to safe practices to prevent the potential spread of food-borne illness to all residents who received their meals from the kitchen. Concerns were noted with dish-washing procedures, sanitizing solution concentrations, cleaning contact surfaces after exposure to raw meat, failure to remove significantly dented cans from the general canned food supply, and cleanliness in the dry food store room.

Inspectors wroteBased on interview and document review, the facility failed to support the residents' right to participate in a resident group by not restarting the resident council meetings post Coronavirus Disease 2019 (COVID-19). This deficient practice affected four residents in the sample of 34 (Resident Identifier (RI) #'s 85, 2, 39 and 53).

Inspectors wroteBased on interview, record review, document review, facility assessment, policy review and review of Centers for Medicare and Medicaid memo, the facility failed to ensure pharmacy services thoroughly reviewed the resident medication regimens to identify irregularities related to the use of psychotropic medications, and residents who were prescribed psychotropic medications received gradual dose reductions (GDR) or had a physician documented clinical rationale for the continued use of the psychotropic medication for four (Resident Identifier (RI) #32, RI#76, RI#75 and RI#18) of five residents reviewed for unnecessary psychotropic medication.

Inspectors wroteBased on record review, staff interviews, review of the facility's assessment, review of the manufacturer's guidelines for medication use, review of Centers for Medicare and Medicaid Services memo and review of the facility's policies and procedures, the facility failed to ensure that four of five residents (Resident Identifier (RI) #18, RI#32, RI#75, and RI#76) were free from unnecessary psychotropic medications. Specifically, an antipsychotic and psychoactive medications were used by the facility without an attempted gradual dose reduction (GDR), proper medical rationale, proper indication for use, and the lack of /or behavior and side effect monitoring. Additionally, residents received PRN (as needed) anti-anxiety medication for more than 14 days without proper medical rationale and/or indication for use.

Inspectors wroteBased on interview, record review and facility policy review, the facility failed to notify the responsible party for one of 34 sampled residents (Resident Identifier (RI) #74) of a change in medical treatment and new medical diagnosis. Specifically, an indwelling urinary catheter was inserted without notification of the responsible party.

Inspectors wroteBased on interview, record review, document review and review of the Long-Term Care Resident Assessment Instrument, the facility coded the MDS incorrectly for two of 34 residents, Resident Identifier (RI) #75 and 32. Specifically, RI#75 was not coded as receiving hospice services and RI#32 was coded as not being administered an antipsychotic medication.

Inspectors wroteBased on interview, document review and record review, the facility failed to develop a plan of care for three (Resident Identifier (RI) #32, RI#74 and RI#75) of 34 residents reviewed for care plans. Specifically, RI #32 was prescribed Abilify, an antipsychotic medication without developing and identifying specific target behavior/s and non-pharmacological interventions for the use of the medication. RI#74 care plan did not reflect interventions for the care of the resident with limited Range of Motion (ROM) and contractures. RI#75's care plan did not address that the resident had an indwelling urinary catheter and the intervention that nursing staff were to provide catheter care per shift and PRN (as needed).

Inspectors wroteBased on interview, document review and record review, the facility failed to ensure two of 34 sampled residents requiring assistance with activities of daily living (ADLs) (Resident Identifier (RI) #93 and RI#32) and one supplemental resident who wished to remain anonymous received their scheduled baths.

Inspectors wroteBased on record review, document review and interview, the facility failed to provide an ongoing program to support residents in their choice of activities designed to meet the interests of and support the well-being of each resident for three of 34 residents, Resident Identifier (RI) #'s 85, 39 and 53, reviewed for activities.

Inspectors wroteBased on observation, interviews, and review of Potter and [NAME], Fundamentals of Nursing, Ninth Edition, page 465, Chapter 29, Infection Prevention and Control, the facility failed to ensure a licensed nurse did not assist with repositioning and adjusting Resident Identifier (RI) #11's bed linens while still wearing gloves worn during wound care for RI #11. This deficient practice affected RI #11, one of one residents observed during wound care. Findings Included: A review of Potter and [NAME] Fundamentals of Nursing, Ninth Edition, page 465, Chapter 29, Infection Prevention and Control, revealed the following under the heading, Gloves: . Change gloves and perform hand hygiene between tasks and procedures on the same patient after contact with material that contains a high concentration of microorganisms. RI #11 was readmitted to the facility on [DATE]. [...]