Diversicare of Riverchase

Inspectors wroteBased on observation, interviews, and review of a facility policy Handwashing/Hygiene, and a facility tool titled Peri Care Audit Tool, the facility failed to ensure the Certified Nursing Assistant (CNA) washed or sanitized her hands between glove changes and did not place a clean cloth and clean brief under the resident with the same gloves she had on to clean bowel movement from the resident. This was observed on 6/30/21 and affected Resident Identifier (RI) #84 one of two residents observed for incontinent care. Findings Include: A review of a facility policy Handwashing/Hand Hygiene, with an effective date of 11/1/17, revealed . POLICY INTERPRETATION AND IMPLEMENTATION . 5. Use an alcohol based rub or, alternatively, soap . and water for the following situations: . h. before moving from a contaminated body site to a clean body site during resident care; . j. [...]

Inspectors wroteBased on observation, interview, the 2017 Food and Drug Administration (FDA) Food Code, the facility's policy on Dry Storage, and the facility's policy on Team Member Sanitary Practices, the facility failed to ensure: 1.) the food preparation sink's drain pipe did not extend into the floor drain, 2.) the ceiling of the Walk-in Cooler was free of removable dark matter, 3.) the shelving in the dry storage area was at least six inches from the floor, 4.) shredded chicken salad was discarded by the manufacturer's expiration date, 5.) staff with facial hair wore beard guards in the kitchen and food preparation areas, and 6.) staff did not chew gum in the kitchen area. This had the potential to affect 108 residents receiving meals from the kitchen, 108 of 111 residents in the facility.

Inspectors wroteBased on observations, interviews, the facility's recipe for Pureed Asian Chicken, and the facility's recipe for Pureed Oriental Vegetables, the facility failed to prepare pureed foods per recipe instructions in order to maintain the nutritional content and flavor at lunch on 10/2/19. This had the potential to affect all residents on puree diets in the facility, 16 of 108 residents receiving meals from the kitchen.

Inspectors wroteBased on observations, and interviews the facility failed to ensure the call system was working properly on the east wing. This affected 60 of 60 residents residing on the east wing. Findings Include: On 10/01/19 at 02:47 PM, Resident Identifier (RI) #44 had the call light on. The call light was answered at 03:32 PM, by Employee Identifier (EI) #10 Unit Manager (UM). She was asked where the call bell rang to and she said the front nurse's station. On 10/01/19 at 05:14 PM, RI #44 was asked to push the call light and the surveyor walked up to nursing station and a light was lighting up on the call light box, but there was no sound. room [ROOM NUMBER] came on as well and it was not sounding. On 10/01/19 at 05:27 PM, room [ROOM NUMBER] light came on box and was not beeping. On 10/01/19 at 05:32 PM, a maintenance staff was asked to push all the call lights on the light board. [...]

Inspectors wroteBased on observations, record review, and interview the facility failed to ensure Resident Identifier (RI) #47 had a palm guard on the left hand as ordered. This affected one of eleven residents sampled for Range of Motion. Findings Include: RI #47 was admitted to the facility on [DATE]. A diagnosis included Hemiplegia and Hemiparesis following Cerebral Infarction affecting right dominant side. A physician order dated 7/31/19 revealed, Caregivers to ensure that blue palm guard is in L (left) hand at all times after proper hygiene. On 10/01/19 at 12:31 PM, a sign was observed above RI #47's bed that stated, must wear palm guard at all times except during cleaning. RI #47 was observed with the left arm contracted, and not wearing a palm guard in the hand. On 10/01/19 at 04:38 PM, RI #47 was observed without a palm guard to the left hand. [...]

Inspectors wroteBased on observation, interview, and review of a facility form titled: Indwelling Cath (Catheter) Audit Tool, the facility failed to ensure: 1. a Certified Nursing Assistant (CNA) Employee Identifier (EI) #1, removed soiled gloves and washed her hands prior to touching Resident Identifier (RI) #76's urinary catheter, clean brief, and urinal used for emptying urine from RI #76's bed side drainage bag, and 2. RI # 86 had an order for a catheter. This affected two of four residents sampled with urinary catheters. Findings Include: 1) A facility form titled: Indwelling Cath Audit Tool, with no effective date, revealed; Action . 2. wash hands . 3. Apply/don gloves. 4. Starting close to the urinary meatus, clean the catheter tubing in a circular motion along its length for about 6 inches, moving away from the body x 2 while changing position of the cloth. 5. STOP! Removes gloves. [...]

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure the Prescription Drug Destruction Inventory log for controlled substance, dated 01/10/2019, had three signatures verifying controlled substance destructions. This affected one of thirteen months of facility narcotic destruction logs that were reviewed. Findings Include: On 10/03/2019 at 4:30 PM, the surveyor reviewed narcotic Prescription Drug Destruction Inventory logs for the previous 13 months. The log dated 01/10/19 was observed to have only two signatures. The January 2019 Prescription Drug Destruction Inventory log indicated that Oxycodone, Zolpidem, Lorazepam, Tramadol, Alprazolam, Morphine and Fentanyl had been destroyed by the Consultant Pharmacist and the Director of Nursing Service (DON). There was no third signature observed. [...]

Inspectors wroteBased on observation, interviews, medical record review, and a review of a facility form titled, Hand Hygiene Care Audit, the facility failed to ensure Certified Nursing Assistants (CNA) washed their hands after removing their gloves when performing incontinence care on Resident Identifier (RI) #88 and RI #106. Further, the facility failed to ensure a Licensed Nurse used a clean bandage scissor to cut a sterile dressing while performing wound care on RI #88. This affected two of three residents observed for incontinence care and one of three residents observed for wound care. Findings Include: A review of a facility form titled: Hand Hygiene Care Audit, revealed: Hand Hygiene . 3. Hand Hygiene is done every time you remove gloves. 4. Hand washing is done every time you go from a dirty area to a cleaner area. Gloving . 8. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure pureed foods were consistently served from the tray line at recommended safe and sanitary temperatures of 135 degrees Fahrenheit (F) or higher. Pureed casserole and fortified mashed potatoes were served from the 11/14/18 lunch tray line at substandard temperatures. This had the potential to affect all 15 residents for whom pureed meals were planned.